LP1: Alterations in Fluid & Electrolytes

B (vascular)

-Albumin attracts to fluids (if fluids are at a normal level) and stays in the ______ system A.) Arterial B.) Vascular

C (Oncotic Pressure or colloidal osmotic pressure)

-____ ____ exerted by colloids in solution. -Protein is the major colloid & since proteins are lg. molecules they won't escape the vascular system and instead will stay in the vascular system unless of a burn or trauma (Albumin is used for this) A (Oncotic Pressure/Colloidal osmotic pressure) B (Hydrostatic Pressure)

A (Increase in Blood Osmolality and decrease in Blood Volume-pressure receptors activated)

2 physiologic changes that can cause ADH to be secreted is... A.) Increase in Blood Osmolality and a decrease in blood volume B.) Decrease in Blood Osmolality and a increase in blood volume C.) Decrease in Blood Osmolality and a decrease in blood volume D.) Increase in Blood Osmolality and a increase in blood volume

A (The hydrostatic pressure in the venous system is increased and it is pushing fluid out; the heart is not able to effectively pump all of the blood coming to it b/c it is failing. Therefore fluid backs up into the venous system and increases the plasma or venous hydrostatic pressure. Increased plasma or venous hydrostatic pressures causes fluid to move out of the vessel. Elevating the extremity will lower the pressure in the veins = more blood will return to the heart. Lowering the plasma or venous hydrostatic pressure will cause less fluid to leave the blood vessel and allow more blood to enter the blood vessel.)

A client with CHF has 2+ pedal edema. Considering the dynamics of the four pressures, why is this edema occurring? A.) The hydrostatic pressure in the venous system is increased and it is pushing fluid out. B.) The plasma osmotic pressure in the venous system is increased and it is pushing fluid out. C.) The hydrostatic pressure in the venous system is decreased and it is pulling fluid in D.) The plasma hydrostatic pressure in the venous system is decreased and it is pushing fluid out

A (There is decreased venous end hydrostatic pressure by elevating the leg; when the capillaries are above the level of the heart or elevated, the circulation is decreased slightly so then hydrostatic pressure is decreased and less is pushed on the capillary.)

A client with a sprained ankle is instructed to keep their extremity elevated. Considering the capillary dynamics of the four pressures, how will this action control the amount of edema? A.) There is decreased venous end hydrostatic pressures by elevating the leg B.) There is increased venous end hydrostatic pressures by elevating the leg C.) There is decreased arterial end hydrostatic pressures by elevating the leg D.) There is increased arterial end hydrostatic pressures by elevating the leg

B (less; b/c we have less protein to hold onto anything so fluid says "I need to shift from low protein to high protein so it will move into the tissue; patient's w/ low albumin levels have a lot of edema b/c the vascular system cannot hold on to the fluid..they may have a decreased BP b/c there is no fluid in the vascular system. Tx is to have pt. ambulate, increase activities and increase albumin thru TPN, shakes, IV, etc.)

A client with liver failure is not synthesizing albumin properly. This client has a serum albumin of 2.1 g/dl. Plasma osmotic pressure will be affected by this lab result. Will more or less fluid be held in the vascular system? A.) more B.) less

Plasma Osmotic; less; decreased (Normal range of albumin 3.4-5.4g/dL--loss the ability to pull water into the intravascular compartment and hold it there=solutes in the interstitial space in the cell is higher=will pull H2O and see ankle edema)

A client with liver failure is not synthesizing albumin properly. This client has a serum albumin of 2.1 g/dl. Which of the four pressures (plasma hydrostatic, plasma osmotic, tissue hydrostatic or tissue osmotic) will be affected by this lab result? -Will more or less fluid be held in the vascular system? -What would the BP most likely be? (increased or decreased?)

B (100)

A healthy person needs ____mL of H2O/100 calories ingested to help with elimination and wastes. A.) 50 B.) 100 C.) 150 D.) 200

C (It is decreased because the heart's pumping pressure has been decreased d/t poor heart function. This results in decreased hydrostatic pressure at the arterial end of the capillary, which in turn leads to decreased filtration from the capillary to the tissues. Consequently, this decreased pressure will result in an increase of fluids and solutes moving into the capillary from the tissues, disrupting fluid balance and potentially leading to fluid volume overload within the vascular system.)

A patient has CHF that is causing decreased cardiac output. What pressure gradient would be altered within the capillary? A.) Osmotic pressure is decreased at the arterial end of the capillary B.) Osmotic pressure is decreased at the venule end of the capillary C.) Hydrostatic pressure is decreased at the arterial end of the capillary. D.) Hydrostatic pressure is decreased at the venule end of the capillary

C (glucose; increases b/c lots of particles)

Adrenal Cortex-Glucocorticoids-Cortisol -If a patient has increased cortisone levels, what lab value also increases? -If you have a lot of ______(first answer) floating around in your blood, what will happen to your blood osmolality? A.) insulin; decreases B.) insulin; increases C.) glucose; increases D.) glucose; decreases

C (Diabetes Insipidus; high)

Adrenal Cortex-Glucocorticoids-Cortisol: What disease process might have high glucose all the time? Will osmolalility be low or high? A.) Cushing's Syndrome; low B.) SIADH; high C.) Diabetes Insipidus; high D.) Hypoparathyroidism; low

A (Cushing's Syndrome)

Adrenal Cortex-Mineralocorticoids-Aldosterone: What disease has an increased aldosterone release? Some signs and symptoms are increased fluids, Na+ retention, Round moon face... A.) Cushing's Syndrome B.) SIADH C.) Diabetes Insipidus D.) Hypoparathyroidism

C (glomerulus; efferent)

Analogy of Kidney Function: You have 3 open lanes going into the kidney (like a highway). Then you have to filter through the ________(1) but the way you filter is b/c there is a pressure gradient that is set up by the lane going out to the ________(1) which is called the ______ (2) arteriole and that's only one lane. Three lanes in and one lane out sets up a pressure difference. -Ex.) You are on the highway and you are late for school. You're going 70 mph and you see "road construction ahead: one lane" ??What does that do for your pressure? IT INCREASES! It's exactly what happens in the kidneys. You've got 3 in and 1 out and you have a nice filtration pressure set up. So you filter, boom!, into the toilet. A.) nephron; efferent B.) nephron; afferent C.) glomerulus; efferent D.) glomerulus; afferent

Hydrostatic

Arterial ____ Pressure (Hydrostatic or Osmotic?): Deliver O2 and nutrients to tissues and cells.

B (Plasma Osmotic-Colloidal Oncotic-Pressure)

Blood is pulling H2O from the tissue inward=inward force A.) Plasma Hydrostatic Pressure B.) Plasma Osmotic (Colloidal Oncotic) Pressure C.) Tissue Hydrostatic Pressure D.) Tissue Osmotic Pressure

A (Plasma Hydrostatic Pressure)

Blood is pushing from the blood vessel=outward force A.) Plasma Hydrostatic Pressure B.) Plasma Osmotic (Colloidal Oncotic) Pressure C.) Tissue Hydrostatic Pressure D.) Tissue Osmotic Pressure

D (A&B; ANP & BNP are hormones released by the heart because the heart is saying it has too much fluid = stretching the ventricles = ventricles will release BNP or ANP = will help diuresis/ decrease blood volume by decreasing fluid)

Cardiac Regulation: How does the heart work to regulate fluids? (Ex. In heart failure patients we monitor what labs to know that they are in heart failure?) A.) ANP B.) BNP C.) CNP D.) A & B E.) All of the Above

E (A & C)

Cardiac Regulation: What hormones are released by the heart because the heart is saying it has too much fluid = stretching the ventricles = ventricles will release __________ = will help diuresis/ decrease blood volume by decreasing fluid b/c these natriuretic peptides are antagonists to the RAAS are are produced in response to increased atrial pressure A.) BNP B.) CNP C.) ANP D.) All of the Above E.) A & C

B (Natriuertic peptides)

Cardiac Regulation: What suppresses secretion of aldosterone, renin, and ADH to decrease blood volume and pressure? A.) aldosterone B.) Natriuertic peptides C.) Cortisol D.) Angiotensinogen

C (Natriuertic peptides)

Cardiac Regulation: _______ is produced by cardiomyocytes (BNP) in response to increased atrial pressure. A.) aldosterone B.) cortisol C.) Natriuertic peptides D.) Angiotensinogen

T

Cardiac Regulation: T or F? -ANP & BNP hormones are released by the heart because the heart is saying it has too much fluid = stretching the ventricles = ventricles will release ANP & BNP= will help diuresis/ decrease blood volume by decreasing fluid b/c these natriuretic peptides are antagonists to the RAAS are are produced in response to increased atrial pressure. -With heart failure, you will see this increase but unfortunately with heart failure you don't have these mechanisms in place that can excrete fluid b/c we have this vicious cycle and eventually it stops working b/c we have too much ADH released. The heart can regulate fluid balance only to a point.

T

Cardiac Regulation: T or F? -Natriuretic peptides are antagonists to the RAAS & are produced by cardiomyocytes (BNP) in response to increased atrial pressure. -They also suppress secretion of aldosterone, renin, and ADH to decrease blood volume and pressure

B (Albumin)

Constitutes about 7% of the blood plasma. It is a large protein molecule that can't pass through the walls fo teh capillary. _____ is like a water magnet, attracting water and holding it inside the capillary vessel. A.) Plasma B.) Albumin C.) Hydrostatic D.) Osmotic

A.) decreased

Ex.) In a patient with a _______ albumin level, you will start seeing edema in the extremities such as ascites, pleura effusions (lungs), and pericardial effusions (heart), etc. -Albumin attracts to fluids (if fluids are at a normal level) and stays in the vascular system A.) decreased B.) increased

B (#1=I, #2=I, #3=I, #4=D, #5=I, #6=I, #7=I)

Factors affecting aldosterone secretion: -Decreased renal perfusion (decreased plasma volume ("I"=increase, "D"=decrease) 1.)_____Renin Secretion 2.)_____Plasma angiotensin II 3.)_____Serum K+ 4.)_____Serum Na+ 5.)_____Aldosterone secretion 6.)_____Na+ reabsorption 7.)_____K+ excretion A.) I (1), D(2), D(3), D(4), I(5), I(6), D(7) B.) I (1), I (2), I (3), D (4), I (5), I(6), I(7) C.) D (1), D(2), I(3), D(4), I(5), D(6), D(7) D.) D(1), D(2), I(3), I (4), D (5), I(6), D(7)

A (increased)

Factors affecting aldosterone secretion: -Stress, physical trauma results in increased or decreased ACTH? A.) increased B.) decreased

Deficit

Fluid Volume ____: (Deficit or Excess) dehydration or the loss of fluids and electrolytes (may be d/t vomiting, diarrhea, excessive sweating, fever, or nasogastric suction) -Symptoms: Decreased BP, dry mucous membranes, decreased urine output, thirsty, weight loss, poor skin turgor

Excess

Fluid Volume _____: (Deficit or Excess) condition of fluid overload or fluid retention (body retains H2O and Na+) -Symptoms: Moist Crackles (Rales) in lungs, Rapid Bounding Pulse, Increased BP, S.O.B., Frequent Moist Cough, Weight Gain

Capillaries

Function of...? -Maintain temperature -Deliver nutrients -Pick up wastes

D (Decreased movement of water from the capillaries to the interstitial fluid; Osmotic pressure is the tendency of water to diffuse from an area of lower solute concentration to an area of high solute concentration. Albumin is an osmotically active plasma protein and is one of the primary determinants of the blood's osmotic or oncotic pressure. If a membrane is impermeable to a particular solute, then water will diffuse across the membrane until the differences in the solute concentrations have been equilibrated. An infusion of albumin would create a greater concentration of albumin in the capillaries than in the interstitial fluid that bathes the capillaries. Water would therefore move from the interstitial fluid into the capillaries.)

If albumin, a plasma protein, is given intravenously, which of the following changes would you expect to find in the capillaries? A.) Increased permeability to albumin B.) Decreased permeability to albumin C.) Increased movement of water from the capillaries to the interstitial fluid D.) Decreased movement of water from the capillaries to the interstitial fluid

A (high)

If hydrostatic pressure is too ____, it's going to push fluid out. A.) high B.) low

B (low)

If oncotic pressure is too ____ it's not going to hold on to fluid. A.) high B.) low

Right

If we have a fatal ___ (left or right) ventricle: bring blood back from the bottom of the heart or body and top of body (SVC + IVC) = get back pressure and get puffy everywhere. With this ventricle, you either die or get a new heart.

Left

If we have a fatal ___ (left or right) ventricle: we get back flow to tissue spaces in the pulmonary end=crackles!

A (albumin)

If you don't have enough albumin within the vascular system, the fluid will go into the tissues because there is not enough ____ to attract too. A.) albumin B.) fluid

A (increase)

Interstitial fluid to plasma: -Fluid is drawn into the plasma space w/ an _______ in plasma osmotic or oncotic pressure -Compression stockings (TEDS/SCD's) decrease peripheral edema A.) increase B.) decrease

B (Angiotensin 1; angiotensin 2)

Kidney Physiology by Barb Bancroft: The RAS System -At any given moment the kidney is saying to you, what's barb's blood pressure? What's barb's volume? So it looks at pressure and volume all the time. How much do you filter through the kidney a day? 180 L. All that is going through your body all day and is sensing your volume and your pressure. Now what if I had low volume and low pressure? What would my kidneys say? I can help. And I'm going to put a word out there that we have heard a million times, and its called renin. Renin has absolutely no function at all except as a messenger. So as soon as the kidney releases renin, renin goes running over to the liver like a tattle tell. Renin asks...can _____(1) come out and play? _____(1) says sure, why not. So when _____(1) is produced, it is just a messenger, no function at all until it is changed into _____(2). And you gotta convert, and you do it through an enzyme named ACE. Who's ACE? Angiotensin-Converting Enzyme. Angiotensin 2 is the functioning hormone...and she does exactly what she says she does! Because what is your angio's? She tenses them. And you started out with low pressure, so we pumped her up to increase her pressure. So she tenses your angio's. Now there's one other thing we have to do and that's increase your volume, cause you started out with low volume too. So angie will not come out and play unless her best friend does. So she runs over to the adrenal gland and says what? Can Al come out and play? Who's Al? Aldosterone! So of course Angie and Al do things together all the time. So first thing angie does is tenses your angios, vasoconstricts and BP goes up. Second thing she does is runs over to Al, and says get out. Quit taking a nap and lets play. And out comes Al and says well i gotta increase volume so I'm going to save sodium and whenever you save sodium, whose the biggest nerd in your body? Water! Water follows anybody, anywhere. So if sodium is coming back in, water is saying I'm coming with you. Now of course when you save a cation called Na+, you're going to have to get rid of another +, you can't just have all these plusses coming in. You gotta pick a plus out and who we gonna kick out? K+! A.) Renin; angiotensin 1 B.) Angiotensin 1; angiotensin 2 C.) Angiotensin 2; aldosterone D.) Aldosterone; renin

D (aldosterone)

Kidney Physiology by Barb Bancroft: The RAS System -At any given moment the kidney is saying to you, what's barb's blood pressure? What's barb's volume? So it looks at pressure and volume all the time. How much do you filter through the kidney a day? 180 L. All that is going through your body all day and is sensing your volume and your pressure. Now what if I had low volume and low pressure? What would my kidneys say? I can help. And I'm going to put a word out there that we have heard a million times, and its called renin. Renin has absolutely no function at all except as a messenger. So as soon as the kidney releases renin, renin goes running over to the liver like a tattle tell. Renin asks...can angiotensin 1 come out and play? angiotensin 1 says sure, why not. So when angiotensin 1 is produced, it is just a messenger, no function at all until it is changed into angiotensin 2. And you gotta convert, and you do it through an enzyme named ACE. Who's ACE? Angiotensin-Converting Enzyme. Angiotensin II is the functioning hormone...and she does exactly what she says she does! Because what is your angio's? She tenses them. And you started out with low pressure, so we pumped her up to increase her pressure. So she tenses your angio's. Now there's one other thing we have to do and that's increase your volume, cause you started out with low volume too. So angie will not come out and play unless her best friend does. So she runs over to the adrenal gland and says what? Can ______(1) come out and play? Who's ______(1)? ________(1)! So of course Angie and ______(1) do things together all the time. So first thing angie does is tenses your angios, vasoconstricts and BP goes up. Second thing she does is runs over to ______(1), and says get out. Quit taking a nap and lets play. And out comes ______(1) and says well i gotta increase volume so I'm going to save sodium and whenever you save sodium, whose the biggest nerd in your body? Water! Water follows anybody, anywhere. So if sodium is coming back in, water is saying I'm coming with you. Now of course when you save a cation called Na+, you're going to have to get rid of another +, you can't just have all these plusses coming in. You gotta pick a plus out and who we gonna kick out? K+! A.) Renin B.) Angiotensin 1 C.) Angiotensin 2 D.) Aldosterone

B (ACE; angiotensin 2)

Kidney Physiology by Barb Bancroft: The RAS System -At any given moment the kidney is saying to you, what's barb's blood pressure? What's barb's volume? So it looks at pressure and volume all the time. How much do you filter through the kidney a day? 180 L. All that is going through your body all day and is sensing your volume and your pressure. Now what if I had low volume and low pressure? What would my kidneys say? I can help. And I'm going to put a word out there that we have heard a million times, and its called renin. Renin has absolutely no function at all except as a messenger. So as soon as the kidney releases renin, renin goes running over to the liver like a tattle tell. Renin asks...can angiotensin 1 come out and play? angiotensin 1 says sure, why not. So when angiotensin 1 is produced, it is just a messenger, no function at all until it is changed into angiotensin 2. And you gotta convert, and you do it through an enzyme named ______(1). Who's _____(1)? ______________(1). ________(2) is the functioning hormone...and she does exactly what she says she does! Because what is your angio's? She tenses them. And you started out with low pressure, so we pumped her up to increase her pressure. So she tenses your angio's. Now there's one other thing we have to do and that's increase your volume, cause you started out with low volume too. So angie will not come out and play unless her best friend does. So she runs over to the adrenal gland and says what? Can Al come out and play? Who's Al? Aldosterone! So of course Angie and Al do things together all the time. So first thing angie does is tenses your angios, vasoconstricts and BP goes up. Second thing she does is runs over to Al, and says get out. Quit taking a nap and lets play. And out comes Al and says well i gotta increase volume so I'm going to save sodium and whenever you save sodium, whose the biggest nerd in your body? Water! Water follows anybody, anywhere. So if sodium is coming back in, water is saying I'm coming with you. Now of course when you save a cation called Na+, you're going to have to get rid of another +, you can't just have all these plusses coming in. You gotta pick a plus out and who we gonna kick out? K+! A.) Renin; angiotensin 1 B.) ACE; angiotensin 2 C.) Angiotensin 2; aldosterone D.) Aldosterone; renin

D (180 L; renin)

Kidney Physiology by Barb Bancroft: The RAS System -At any given moment the kidney is saying to you, what's barb's blood pressure? What's barb's volume? So it looks at pressure and volume all the time. How much do you filter through the kidney a day? _______L(1). All that is going through your body all day and is sensing your volume and your pressure. Now what if I had low volume and low pressure? What would my kidneys say? I can help. And I'm going to put a word out there that we have heard a million times, and its called ______(2). _____(2) has absolutely no function at all except as a messenger. So as soon as the kidney releases _____(2), _____(2) goes running over to the liver like a tattle tell. _____(2) asks...can angiotensin 1 come out and play? Angiotensin 1 says sure, why not. So when angiotensin 1 is produced, it is just a messenger, no function at all until it is changed into angiotensin 2. And you gotta convert, and you do it through an enzyme named ACE. Who's ACE? Angiotensin-Converting Enzyme. Angiotensin 2 is the functioning hormone...and she does exactly what she says she does! Because what is your angio's? She tenses them. And you started out with low pressure, so we pumped her up to increase her pressure. So she tenses your angio's. Now there's one other thing we have to do and that's increase your volume, cause you started out with low volume too. So angie will not come out and play unless her best friend does. So she runs over to the adrenal gland and says what? Can Al come out and play? Who's Al? Aldosterone! So of course Angie and Al do things together all the time. So first thing angie does is tenses your angios, vasoconstricts and BP goes up. Second thing she does is runs over to Al, and says get out. Quit taking a nap and lets play. And out comes Al and says well i gotta increase volume so I'm going to save sodium and whenever you save sodium, whose the biggest nerd in your body? Water! Water follows anybody, anywhere. So if sodium is coming back in, water is saying I'm coming with you. Now of course when you save a cation called Na+, you're going to have to get rid of another +, you can't just have all these plusses coming in. You gotta pick a plus out and who we gonna kick out? K+! A.) 270L; angiotensin 1 B.) 300L; angiotensin 2 C.) 180L; aldosterone D.) 180 L; renin

A (afferent; Prostaglandins)

Kidney Physiology: Blood flows into the kidney through the front door called the ______ arteriole. Your _____(1) arteriole is always wide open or maintained in a vasodilated state so that you can get enough blood through the kidney and what keeps it open are called __________(2). __________(2) are produced every day to keep our kidneys vasodilated. A.) afferent; Prostaglandins B.) efferent; aldosterone C.) afferent; ADH D.) efferent; aldosterone

Osmotic

Plasma ______ (Osmotic or hydrostatic?)(Colloidal Oncotic) Pressure: Inward force where albumin within the capillary is PULLING water from the tissues. This happens throughout the capillary but exerts greater pressure at the venule end.

Hydrostatic

Plasma ______ Pressure (Hydrostatic or Oncotic): Outward force where fluids and nutrients are being PUSHED from the vessel to the tissues (happening at the arteriole end)

venous (this is also considered venous stasis = increased hydrostatic pressure at the venous end)

Pressures Ex.: Pregnant woman around the 8th or 9th month of pregnancy = get swollen ankles b/c their is a mass/baby sitting on abdomen exerting a lot of pressure on ____ (venous or arterial) end pressures. -Same Concept: sitting crunched on an airplane for several hours, wearing very tight jeans, obese patients

C (Capillaries)

Primary Function of: -When the hydrostatic (pushing) pressure builds INSIDE a _______, it causes filtration, forcing fluids and solutes out through the capillary walls into the tissues, thus delivering nutrients. A.) Blood Vessels B.) Arteries C.) Capillaries D.) Arterioles

A (Capillaries)

Primary Function of: -When the pressure inside the capillary is less that the pressure outside it, fluids and solutes move back into the capillary A.) Capillaries B.) Arteries C.) Blood Vessels D.) Arterioles

A (Arterial Force)

Pushing the nutrients out A.) Arterial Force B.) Venous Force

C (Renal Tubules)

Renal Regulation: -What are the sites of action of ADH and aldosterone? -Ex.) Body/Kidneys say there is not enough fluid=message sent to hypothalamus to tell posterior pituitary to release ADH...aldosterone and RAS system then kicks in A.) Bowman's Capsule B.) Nephron C.) Renal Tubules D.) Ureter

D (Increased Tissue hydrostatic pressure)

Shifts of interstitial fluid to plasma: The wearing of TED Hose to decrased peripheral edema is a therapeutic application of what mechanism? A.) Increased Venous Hydrostatic Pressure B.) Decreased Plasma Oncotic Pressure C.) Increased Interstitial Oncotic Pressure D.) Increased Tissue Hydrostatic Pressure

D (Increased plasma oncotic pressure)

Shifts of interstitial fluid to plasma: What mechanism could happen w/ administration of colloids, dextran, mannitol, or hypertonic solutions? A.) Increased Venous Hydrostatic Pressure B.) Decreased Plasma Oncotic Pressure C.) Increased Interstitial Oncotic Pressure D.) Increased Plasma oncotic Pressure

A (Increased venous hydrostatic pressure)

Shifts of plasma to interstitial fluid: Causes of this mechanism include...fluid overload, heart failure, liver failure, obstruction of venous return to the heart (ex. tourniquets, restrictive clothing, venous thrombosis) & venous insufficiency (varicose veins)? A.) Increased Venous Hydrostatic Pressure B.) Decreased Plasma Oncotic Pressure C.) Increased Interstitial Oncotic Pressure D.) Increased Tissue Hydrostatic Pressure

B (Decreased Plasma Oncotic Pressure)

Shifts of plasma to interstitial fluid: What mechanism can result from excessive protein loss (renal disorders), deficient protein synthesis (liver disease), and deficient protein intake (malnutrition)? A.) Increased Venous Hydrostatic Pressure B.) Decreased Plasma Oncotic Pressure C.) Increased Interstitial Oncotic Pressure D.) Increased Tissue Hydrostatic Pressure

C (Increased Interstitial Oncotic Pressure

Shifts of plasma to interstitial fluid: What mechanism can result from trauma, burns, and inflammation which can damage capillary walls and allow plasma proteins to accumulate in the interstitium? A.) Increased Venous Hydrostatic Pressure B.) Decreased Plasma Oncotic Pressure C.) Increased Interstitial Oncotic Pressure D.) Increased Tissue Hydrostatic Pressure

T

T or F r/t Fluid Shifts? Plasma to interstitial fluid shift results in edema/end result of fluid shifts is usually edema or 3rd spacing in abdomen, lungs, etc. -Elevation of hydrostatic pressure: pushes fluid out, causing edema -Decrease in plasma oncotic pressure: Albumin causes/affects this (decreased albumin levels) -Elevation of interstitial oncotic pressure (Ex. Burn pt., even sunburn--capillaries open up and can have proteins that move into the tissues so it's going to pull more fluid into the tissues, causing edema)

T

T or F? +1 to +4 edema = not the number of seconds it takes to come up, it is the depth! +1= about 2mm +2= about 4mm +3 =about 6mm +4 =about 8mm

T

T or F? -In a HEALTHY patient: At the venous end, the intravascular pressure or hydrostatic pressure should decrease so you can suck back the wastes into the venous system and then get re-circulated -In a POOR FUNCTIONING HEART: at the arterial end, hydrostatic pressure decreases so much and by the time you get to the venous end, you have so much pressure at the far end in the intravascular space=water leaks out into interstitial space .

T

T or F? -To help increase hydrostatic pressure in patient's who have edema in the lower extremities, we can elevate the legs = causing more pressure pushing fluid down

T

T or F? Another natural thing we can do to help keep fluid in our circulation and go back to the heart is by exercise and walking b/c the muscles are contracting, increasing hydrostatic pressure pushing fluid back into the system.

T (these all help to maintain homeostasis)

T or F? Fluid movement in capillaries is based on the amount and direction determined by: -Capillary Hydrostatic Pressure: push it out to the tissue -Plasma Oncotic Pressure: Helps hold it in -Interstitial Hydrostatic Pressure -Interstitial Oncotic Pressure (interstitial=at the tissue level)

T (Hypo and Pit Reg. often work together)

T or F? These are all regulators of water balance: -Hypothalamic Regulation -Pituitary Regulation -Adrenal Cortical Regulation -Renal Regulation (HUGE FACTOR!) -Cardiac Regulation -Gastrointestinal Regulation -Insensible Water Loss

T

T or F? Adrenal Cortex Regulation (Adrenal Cortex=regulator) -Releases hormones to regulate water and electrolytes -Glucocorticoids (Cortisol)= often released with increased levels of stress = increases cortisone levels -Mineralocorticoids (Aldosterone)= holds on to Na+ & H2O (Na & H2O stay) and K+ is released

F

T or F? Aldosterone causes an increase in sodium and water reabsorption in the renal tubules and is made the posterior pituitary gland.

T

T or F? At the venous end of the capillary, fluid will start going back to the heart.

T

T or F? Hypovolemia (severe blood and fluid loss) is sometimes secondary to loss of oncotic pressures and low serum albumins.

A (Cortisol= often released with increased levels of stress = increases cortisone levels)

The adrenal cortex releases 2 hormones to regulate water and electrolytes. One hormone is glucocorticoids and the other is mineralocorticoids. What does glucocorticoids produce? A (Cortisol= often released with increased levels of stress = increases cortisone levels) B (Aldosterone = holds on to Na+ & H2O -Na & H2O stay- and K+ is released)

A (Cortisol)

The adrenal cortex releases 2 hormones to regulate water and electrolytes. One hormone is glucocorticoids and the other is mineralocorticoids. What does glucocorticoids produce? A.) Cortisol= often released with increased levels of stress = increases cortisone levels B.) Aldosterone = holds on to Na+ & H2O (Na & H2O stay) and K+ is released

A (increased BP;The hypertonic saline will increase the osmolarity of the blood-and other extracellular fluids-, causing fluid to remain in the tissues/plasma volume and drawing fluid from the interstitial space into the plasma volume. The expected early results of these responses are increased BP, decreased edema, & decreased Hematocrit and Hemoglobin levels b/c you are having more fluid being moved into the vascular system.)

The client is receiving 150 mL of 5.0% saline intravenously in the next 2 hours. What response should the nurse expect as a result of this therapy? A.) Increased BP B.) Increased Dependent Edema C.) Increased urine concentration of K+ D.)Increased hematocrit and hemoglobin levels

C (increased ADH secretion;Both increased ADH and decreased aldosterone secretion could result in the low serum sodium level. Decreased aldosterone secretion leads to excessive loss of sodium and water while increasing K+ reabsorption. If decreased aldosterone levels were responsible, the low serum sodium level would be accompanied by a normal or higher than normal level of serum K+. ADH secretion causes increased reabsorption of water only. It's excessive secretion causes a dilutional effect on all serum electrolytes, which is consistent with this client's lab values.)

The client's serum sodium level is 128 mEq/L and serum potassium level is 2.8 mEq/L. Which hormonal problem is most likely to have caused this clinical situation? A.) Increased aldosterone secretion B.) Decreased aldosterone secretion C.) Increased ADH secretion D.) Decreased ADH secretion

B (Venous Force)

The fluid returning to the BP from the tissue to be re-circulated A.) Arterial Force B.) Venous Force

A

The thirst mechanism is controlled by: A.) Angiotensin II and Increased blood Osmolality B.) Aldosterone and ADH C.) Angiotensin II and Decreased Blood Osmolality D.) Pressure Receptors and Decreased Blood Volume

A (Pre-Albumin)

This is a lab most commonly ordered to determine albumin levels/osmotic pressure used to look at a timeline of albumin in the body that is attached to molecules A.) Pre-Albumin B.) Albumin C.) Total Protein D.) Pre-Total Protein

D (Angiotensin II)

This is one of the 4 regulators of Blood Osmolality..it is a "peptide": -Site of Production: Renin acts on angiotensinogen to produce angiotensin 1 which is acted on by ACE (angiotensin-converting enzyme) to make angiotensin II -Site of Action: Acts on the adrenal cortex and vascular smooth muscle -Results: Causes secretion of aldosterone and increases BP through vasoconstriction A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

C (Renin)

This is one of the 4 regulators of Blood Osmolality..it is a "proteolytic enzyme": -Site of Production: juxtaglomerular cells of the afferant arterioles of the renal glomeruli (kidney) -Site of Action: Acts on angio-tensiogen to prodcue angiotensin II -Results: Releases when plasma Na+ levels and/or blood volume/pressure decrease to increase production of aldosterone A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

B (ADH-Antidiuretic hormone...vasopressin)

This is one of the 4 regulators of Blood Osmolality..it is a hormone: -Site of Production: posterior pit. gland, stored in hypothalamus; responds to 1-2% increase in osmolality to cause increase in ADH production and reverse -Site of Action: Arterioles & Renal Tubules -Results: Increases BP & water absorption=reduces urine output A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

A (Aldosterone)

This is one of the 4 regulators of Blood Osmolality..it is a hormone: -Site of production: Adrenal Cortex (kidney) -Site of action: Renal Tubules -Results: Increases Na+ reabsorption (decreases K+ reabsorption) and water retention by the renal tubules A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

A (Capillaries)

This is part of the vascular system that connect arterioles (small arteries that deliver oxygen and nutrient-rich blood to the capillaries) with venules (small vessels connected to capillaries that drain blood into the veins for eventual return to the heart. -Within the vascular system, only _____ have walls thin enough to let solutes pass through A.) Capillaries B.) Arteries C.) Blood Vessels D.) Arterioles

D (Capillaries)

This is the primary function of...? -Delivers nutrients and removes wastes between the blood and tissue cells of the body. Hydrostatic and osmotic pressures inside the _____ and outside the _____ in the tissues work together to maintain fluid balance. A.) Arterioles B.) Arteries C.) Blood Vessels D.) Capillaries

Osmotic

Tissue ____ Pressure (Hydrostatic or Osmotic): Outward force where fluids and nutrients are being PULLED by the tissues from the capillary. This is happening at the arteriole end.

Hydrostatic

Tissue _____ Pressure (Hydrostatic or Osmotic): Inward force where waste fluids are being PUSHED by the tissues into the capillary. This happens at the venule end.

D (Tissue Osmotic Pressure)

Tissue is pulling H2O from the blood vessel=outward force A.) Plasma Hydrostatic Pressure B.) Plasma Osmotic (Colloidal Oncotic) Pressure C.) Tissue Hydrostatic Pressure D.) Tissue Osmotic Pressure

C (Tissue Hydrostatic Pressure)

Tissue is pushing into the blood vessel=inward force A.) Plasma Hydrostatic Pressure B.) Plasma Osmotic (Colloidal Oncotic) Pressure C.) Tissue Hydrostatic Pressure D.) Tissue Osmotic Pressure

True

True or False? The higher the osmolarity, the greater the pulling power.

Hydrostatic

Venous ____ Pressure (Hydrostatic or Osmotic?): Pick up wastes from cells and tissue=recirculate

A (increases)

Wearing TEDS/SCDS ______ hydrostatic pressure b/c they are constricting = pushing fluid back into the venous system and back into circulation A.) increases B.) decreases

C (ECF compartment volume expands, ICF volume contracts; Hypertonic dehydration involves loss of water in greater proportion than the loss of electrolytes form the extracellular fluid-ECF- space, including both the plasma and interstitial spaces. This water loss increases the osmolarity of the remaining plasma, making it hypertonic or hyperosmolar compared w/ normal ECF. The hyperosmolar plasma has an increased osmotic pressure that causes water to move from the ICF into the plasma and interstitial fluid spaces. The fluid shift leads to cellular dehydration and shrinkage. The fluid shift also causes the plasma volume to increase to normal or greater than normal levels. ; Hypertonic dehydration= have more solutes than fluids within the vascular system. So if there is more solutes, you are going to have the ECF expand b/c fluid is going to be pulled out and the ICF will shrink b/c the fluid is being pulled out from the hypertonic state that is occurring.)

What are the fluid compartment consequences of hypertonic (more solutes than fluid) dehydration? A.) ECF compartment volume contracts, ICF volume contracts B.) ECF compartment volume contracts, ICF volume remains the same C.) ECF compartment volume expands, ICF volume contracts D.) ECF compartment volume expands, ICF volume remains the same

C (Angiotensin)

What causes secretion of Aldosterone by the adrenal cortex and increases BP through vasoconstriction? A.) Aldosterone B.) ADH C.) Angiotensin D.) Angiotensin II

C (Renin)

What do the Juxtaglomerular cells release in response to decreased plasma sodium levels? A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

A (Increased osmotic pressure, increased hydrostatic pressure; The addition of albumin to the plasma would add a colloidal substance that does not move into the interstitial space. Thus, the osmotic pressure would immediately increase. Not only does the additional 200 mL add to the plasma hydrostatic pressure, but the increased osmotic pressure would draw water from the interstitial space, increasing the plasma volume and ultimately leading to increased hydrostatic pressure in the plasma volume. Albumin contains bigger particles and we need that to hold fluid within our vascular system so it increases the oncotic/osmotic pressure. Whenever we add more fluid/ volume to the vascular system, you are going to increase the hydrostatic pressure b/c there is more pressure. So as you are adding the albumin to the patient, you are going to increase the osmotic pressure which will pull fluid out of the tissues and into the vascular space, increasing the vascular volume along with the albumin that you are giving and the increased hydrostatic pressure pushing against the tissues itself. Albumin is very important to maintain fluid status and maintain fluid within the vascular system. If you are giving albumin, it is very easy to give patient fluid overload so may see Lasix given w/ this especially with patients with a lot of edema or 3rd spacing to try to pull fluid back into where it belongs.)

What effect would an infusion of 200 mL of albumin have on a healthy client's plasma osmotic and hydrostatic pressures? A.) Increased osmotic pressure, increased hydrostatic pressure B.) Increased osmotic pressure, decreased hydrostatic pressure C.) Decreased osmotic pressure, increased hydrostatic pressure D.) Decreased osmotic pressure, increased hydrostatic pressure

Albumin

What helps to maintain the capillary BP by preventing too much fluid from leaving. As long as the hydrostatic (pushing) pressure is slightly greater than the ____ (plasma or albumin?) colloid osmotic pressure at the arteriole end, water and nutrients will leave the capillaries and move to the tissues.

B (ADH)

What hormone increases BP and increases water absprtion and reduces urine output? A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

A (Aldosterone)

What hormone increases sodium reabsortion and H2O retention by the renal tubes? A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

A (Cortisol-often released with increased levels of stress = increases cortisone levels)

What hormone is released by glucocorticoids that is regulated by the adrenal cortex? -Often Released w/ Increased levels of stress -If patient has increased _____ levels, glucose levels also increasee -Ex.) If you have a lot of glucose floating around in your blood, what will happen to your blood osmolality? Increases b/c it has lots of particles! A.) Cortisol B.) Aldosterone

B (Aldosterone holds on to Na+ & H2O (Na & H2O stay) and K+ is released)

What hormone is released by mineralcorticoids that is regulated by the adrenal cortex? -Holds on to Na+ & H2O (Na & H2O stay) and K+ is released) A.) Cortisol B.) Aldosterone

C (Decreased U.O, Increased Urine Osmolality; ADH binds to receptors in the kidney. Increasing only the reabsorption of water, and increasing plasma volume while decreasing urine volume. Sodium reabsorption is not increased by the presence of ADH, so more sodium remains in the urine, increasing its osmolarity. The outcome of ADH influence is decreased output of urine with a higher concentration -osmolarity.)

What is the expected client response to the presence of antidiuretic hormone (ADH) on urine output and osmolarity? A.) Increased urine output, increased urine osmolarity B.) Increased urine output, decreased urine osmolarity C.) Decreased urine output, increased urine osmolarity D.) Decreased urine output, decreased urine osmolarity

C (Sodium)

What is the major cation in extracellular fluid? (important in controlling and regulating water balance) A.) K+ B.) Ca+ C.) Na+ D.) Mg+

A (Potassium)

What is the major cation in intracellular fluid?(important in maintaining intracellular water balance-also vital for skeletal, cardiac, and smooth muscle transmission and conduction) A.) K+ B.) Ca+ C.) Na+ D.) Mg+

B (6-8)

What is the normal range of Total Protein? A.) 3.4-5.4 B.) 6-8 C.) 8.5-10.5 D.) 3.5-5.5

C (3.4-5.4 g/dL)

What is the normal range of albumin? -Albumin is a high molecular weight protein that exerts a lot of PULLING pressure -Some origins of decreased albumin: liver failure, malnutrition A.) 2.4-4.4 g/dL B.) 3.4-4.4 g/dL C.) 3.4-5.4 g/dL D.) 4.4-6.4 g/dL

D (Kidneys)

What is the primary organ for adjusting urine volume? -They selectively reabsorb water & electrolytes A.) Lungs B.) Liver C.) Urinary Tract System D.) Kidneys

D (Kidneys)

What is the primary organ for regulating fluid and electrolyte balance? -They selectively reabsorb water & electrolytes A.) Lungs B.) Liver C.) Urinary Tract System D.) Kidneys

C (Kidney)

What organ should be filtering and excreting proteins and also keep them in the bloodstream? -We should only be losing proteins in disease process such as Kidney Failure, Burns & Trauma's (burns and trauma allow the vascular system to open up and allow proteins to escape) A.) Liver B.) Heart C.) Kidney D.) Lungs

D (Aldosterone)

What part of the RAS system? ______ says "well i gotta increase volume so I'm going to save sodium" and whenever you save sodium, whose the biggest nerd in your body? Water! Water follows anybody, anywhere. So if sodium is coming back in, water follows. Now when you save a cation called Na+, you're going to have to get rid of another +. You gotta pick a plus out and who we gonna kick out? K+! A.) Renin B.) Angiotensin 1 C.) Angiotensin 2 D.) Aldosterone

A (Adrenal Cortex)

What regulates and releases hormones to regulate water and electrolytes? Ex.) -Glucocorticoids (Cortisol)= often released with increased levels of stress = increases cortisone levels -Mineralocorticoids (Aldosterone)= holds on to Na+ & H2O (Na & H2O stay) and K+ is released A.) Adrenal Cortex B.) Brainstem C.) Efferent Arteriole D.) Afferent Arteriole

C (Renin)

What releases when plasma Na+ levels and/or blodd volume/pressure decrease to increase producton of aldosterone? A.) Aldosterone B.) ADH C.) Renin D.) Angiotensin II

B (Angiotensin 1)

When ________ is produced, it is just a messenger,and it has no function at all. It is considered the "2nd" step of the RAS system: A.) Renin B.) Angiotensin 1 C.) Angiotensin 2 D.) Aldosterone

B (weight loss and increased U.O.; An increased urine output coupled with weight loss is a good indication that overhydration is resolving. A serum sodium level of 133 mEq/L is low and may reflect dilutional hyponatremia or overhydration. A change in urine specific gravity by one unit may indicate the beginning of a trend but by itself is not significant. A narrowing of pulse pressure may indicate the beginning of fluid loss or may be a result of cardiac complications. Again, by itself, the pulse pressure change does not support resolution of the overhydration.; Patient's who are overhydrated may have S&S such as weight gain, edema, decreased urine output, crackles in the lungs, etc.)

Which assessment finding is most important for determining whether interventions for overhydration are effective? A.) Serum sodium level of 133 mEq/L B.) Weight loss and increased urine output C.) Urine specific gravity change from 1.026 to 1.025 D.) Pulse pressure change from 40 mm Hg to 30 mm

A (checking urine output;The blood osmolarity is low. The client could be dehydrated (hypo-osmolar dehydration) or overhydrated, with dilution of blood solute. The most sensitive, noninvasive indicator of circulation adequacy is urine output. In patients who are overhydrated, you are going to see more urine output and if they are dehydrated, they will have less urine output which makes urine output the best indicator of blood osmolarity.)

Which assessment technique would be the best for the nurse to use to determine the adequacy of circulation in a client whose blood osmolarity is 250 mOsm/L? A.) Checking urine output B.) Measuring abdominal girth C.) Monitoring fluid intake D.) Comparing the radial pulse with the apical pulse

C (Pitting edema is usually detected first in dependent areas;Capillary hydrostatic pressure is greater in dependent areas b/c of the influence of gravity, which promotes the process of filtration and leads to the formation of interstitial edema. Hydrostatic Pressure is that pushing pressure and when we look at edema in patient's, often times they have dependent areas and that's where you see that increased hydrostatic pressure and then you get that pitting edema that's usually detected in those dependent areas. For patients who are up and moving, they get a natural return to the heart with the veins contracting the way they should.)

Which clinical manifestation supports the concept that filtration is directly related to hydrostatic pressure? A.) Capillary refill is faster in fingers than in toes. B.) Central venous pressure is lowest in the right atrium. C.) Pitting edema is usually detected first in dependent areas D.) Systolic BP is higher than diastolic BP

Out

Which direction does increased amounts of plasma (vascular) hydrostatic pressure cause fluid to move? Into the blood vessel or out of the blood vessel? Ex.) Too much fluid on board such as too much IV fluids= causes increased pressure at the capillaries

Into (Ex. Putting TED stockings on a patient helps put pressure on the capillaries and push the fluid from the tissue back into the vessel OR Elevating the legs will help push, a.k.a. hydrostatic pressure-fluid back into the vessels and back to the heart.)

Which direction does increased amounts of tissue hydrostatic pressure cause fluid to move? Into the blood vessel or out of the blood vessel? -Ex.) Putting TED stockings on a patient helps put pressure on the capillaries -Ex.) Elevating the legs

Into (Ex. Albumin-Patient has decreased protein in their blood b/c of malnutrition or liver failure. You start increasing their protein intake by giving IV albumin to increase the protein in the blood..protein will pull (osmotic pressure) fluid back into the vascular system from the tissue. We know the patient is getting better when the edema is decreased or gone.)

Which direction does increased plasma (vascular) osmotic pressure cause fluid to move? Into the blood vessel or out of the blood vessel? -Ex.) Albumin

Out

Which direction does increased tissue osmotic pressure cause fluid to move? Into the blood vessel or out of the blood vessel?

D (80 year old woman;Much of the total body water is located inside the muscle cells. Women of any age have less muscle and more fat than a man of the same age, resulting in less total body water and a greater risk for dehydration when exposed to water-losing environmental conditions. As people age, muscle mass is lost. Thus, the person at greatest risk for dehydration is an older woman.)

Which person has the greatest risk for dehydration when exposed to a hot, dry environment for several hours? A.) 50 year old man B.) 50 year old woman C.) 80 year old man D.) 80 year old woman

C (Glucose is immediately metabolized upon administration, leaving pure water in circulation. Dextrose 5% in water is isotonic in its container but, upon reaching the blood, glucose is taken up by cells for metabolism-in the non diabetic client-as rapidly as it is infused, with the remainder of the infused fluid being water. These would be good for patients who are in a hypertonic dehydration of some sort. Dextrose is usually given to patients who are NPO so the cells are getting some type of carbohydrate for cell functioning.)

Why is dextrose 5% in water considered to be a hypotonic solution rather than an isotonic solution, even though its osmolarity is 272 mOsm/L? A.) An isotonic solution must have an osmolarity greater than 300 mOsm/L. B.) Glucose is not an electrolyte and does not completely dissociate in water. C.) Glucose is immediately metabolized upon administration, leaving pure water in circulation. D.) Intravenous glucose immediately draws water from the interstitial and intracellular spaces, resulting in hemodilution.

B (55 year old man w/ Diabetes Insipidus;Hypertonic dehydration occurs when water loss from the extracellular fluid is greater than a proportionate electrolyte loss. The remaining ECF is hypertonic, causing fluid to move from the intracellular space to maintain circulating volume. Thus, the symptoms of hypovolemia are not present. DI contributes to excess water loss and very little electrolytes are lost. In hemorrhage, whole blood w/ fluid and electrolytes is lost, causing isotonic dehydration. The fluid balance problem with heart failure is overhydration. Malnutrition causes the body fluid to be hypotonic from decreased protein and sodium levels.)

With which client should the nurse be most alert for the possibility of hypertonic (more solutes than fluid) dehydration? A.) 52-year-old woman with excessive wound bleeding 4 hours after surgery B.) 55-year-old man with Diabetes Insipidus C.) 80-year-old woman with chronic heart failure D.) 60-year-old man with severe malnutrition

A (Extracellular)

_____ Fluid: -Fluid outside our cells -Ex.) Edema (fluid going into the tissue) A.) Extracellular B.) Intracelluar C.) Interstitial D.) Intravascular

C (Interstitial)

_____ Fluid: part of extracellular fluid: -fluid that surrounds the cells or is between cells (lymph, plasma, transcellular fluid) A.) Extracellular B.) Intracelluar C.) Interstitial D.) Intravascular

D (Intravascular)

_____ Fluid: part of extracellular fluid: fluid or plasma that is found in blood vessels. The blood vessels wrap around cells, bringing O2 and nutrients and removing wastesid: A.) Extracellular B.) Intracelluar C.) Interstitial D.) Intravascular

A (Osmolality)

_____ determines all mechanisms initiated to regulate intake of H2O and excretion. A.) Osmolality B.) Plasma C.) Albumin D.) Potassium

B (Intracellular)

______ Fluid: Fluid inside our cells A.) Extracellular B.) Intracelluar C.) Interstitial D.) Intravascular

D (Transcellular)

______ Fluid: part of the extracellular fluid enclosed by an epithelial membrane or fluid within body compartments (cerebrospinal fluid, synovial joints, pericardial, pancreatic, pleural spaces, GI tract, intraocular, biliary, and peritoneal fluids) -Small but important! -Approximately 1L A.) Extracellular B.) Intracelluar C.) Interstitial D.) Transcellular

A (Renin)

______ has absolutely no function at all except as a messenger and is considered the "1st" step in the RAS system: A.) Renin B.) Angiotensin 1 C.) Angiotensin 2 D.) Aldosterone

C (Angiotensin 2 is the functioning hormone of the RAS system...and she does exactly what she says she does! Because what is your angio's? She tenses them)

_______ is the functioning hormone of the RAS system...and she does exactly what she says she does! A.) Renin B.) Angiotensin 1 C.) Angiotensin 2 D.) Aldosterone