Body Fluid Compartments and Third Spacing

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Questions and Answers

Explain the intra, extra, and intercellular fluid compartments (Explain body fluid compartments)

-Intracellular fluid is the fluid contained within cells, comprising about two-thirds of total body water. It contains solutes like electrolytes and glucose. -Extracellular fluid is the fluid outside of cells, making up about one-third of total body water. -ECF is further divided into:

Interstitial fluid - the fluid between cells and surrounding them, but not inside blood vessels.
Intravascular fluid - the fluid inside blood vessels, also called blood plasma.
Transcellular fluids - fluids contained in epithelial-lined cavities like cerebrospinal, synovial, pleural, and peritoneal fluids. The distribution and composition of these fluid compartments is carefully regulated to maintain proper cellular function, transport nutrients, remove wastes, and provide the optimal internal environment.

Explain third spacing

Third spacing refers to the abnormal shift of fluid from the intravascular space into the interstitial space or body cavities. This can occur in certain medical conditions like ascites, pleural effusions, intestinal obstructions, and severe burns. Although the total body fluid remains the same, the fluid becomes trapped or 'third spaced' outside of the vascular system. This leads to a relative decrease in intravascular volume, which can result in hypovolemic shock if severe enough. Clinically, third spacing presents as edema or fluid accumulation in areas like the abdomen or extremities.

What is the normal range for sodium, and what are the abnormal signs and symptoms associated with it?

-Sodium (Normal range: 135-145 mEq/L)

-Hyponatremia (145 mEq/L): Extreme thirst, confusion, muscle twitches, seizures

What is the normal range for magnesium, and what are the abnormal signs and symptoms associated with it?

-Magnesium (Normal range: 1.8-2.4 mg/dL) -Hypomagnesemia (2.4 mg/dL): Nausea, vomiting, lethargy, respiratory depression Signup and view all the answers

What is the normal range for bicarbonate (HCO3-), and what are the abnormal signs and symptoms associated with it?

-Bicarbonate (Normal range: 22-28 mEq/L) -Low levels: Metabolic acidosis - nausea, fatigue, Kussmaul respirations -High levels: Metabolic alkalosis - confusion, arrhythmias, muscle twitching Signup and view all the answers

What is the normal range for albumin, and what are the abnormal signs and symptoms associated with it?

-Albumin (Normal range: 3.5-5.0 g/dL) -Hypoalbuminemia (5.0 g/dL): Dehydration, rarely symptomatic Signup and view all the answers

What are isotonic solutions?

Isotonic solutions have the same osmotic pressure as blood plasma and cells. They cause no fluid shift between compartments. Examples are 0.9% normal saline, LR, D5W Signup and view all the answers

Explain when a doctor would order hypertonic, isotonic, and hypotonic solutions as a treatment.

-Isotonic solutions like 0.9% normal saline are used to replace fluid losses and maintain intravascular volume without disrupting the fluid balance between compartments. -Hypertonic solutions like 3% saline are used to treat severe hyponatremia (low sodium levels) by raising the sodium concentration in the extracellular fluid and pulling water out of cells. However, they must be administered cautiously to avoid complications. -Hypotonic solutions like 0.45% saline are used to treat hypernatremia (high sodium levels) by diluting the extracellular fluid and allowing water to move into cells. They may also be used for fluid replacement in patients with elevated sodium levels. Signup and view all the answers

What are crystalloids?

Crystalloids are aqueous solutions of electrolytes or other water-soluble molecules. They are used to replace fluid losses, maintain fluid balance, and deliver medications. Examples include normal saline, Ringer's lactate, and dextrose solutions. Crystalloids are given for fluid resuscitation in conditions like dehydration, hypovolemia, and shock. Signup and view all the answers

Explain what this means: Colloid - albumin - hyper-oncotic - expands the plasma volume by about four times its volume.

This statement means that when albumin, which is a colloid solution, is administered intravenously, it has a higher oncotic (osmotic) pressure than blood plasma. This hyper-oncotic property causes fluid from the interstitial spaces to be pulled into the vascular space, effectively expanding the plasma volume by approximately 4 times the volume of albumin infused. Albumin is used to expand intravascular volume in conditions like hypovolemic shock or burns when plasma volume replacement is needed. Signup and view all the answers

Explain how albumin can increase blood pressure, potentially cause pulmonary edema, and increase urination.

Albumin can increase blood pressure by expanding the plasma volume when administered intravenously. The increased blood volume leads to increased venous return to the heart, increasing cardiac output and blood pressure. -Albumin administration can potentially cause pulmonary edema if too much fluid enters the pulmonary vasculature, increasing hydrostatic pressure and leading to fluid leakage into the lung interstitium and alveoli. -Albumin draws fluid from the interstitial spaces into the vascular space due to its oncotic properties. This fluid shift can increase renal perfusion and glomerular filtration rate, resulting in increased urination as the kidneys excrete the excess fluid. Signup and view all the answers

What are the signs and symptoms of fluid volume deficit?

<ul> <li>Thirst and dry mucous membranes</li> <li>Decreased skin turgor and dry skin</li> <li>Sunken eyeballs</li> <li>Orthostatic hypotension (dizziness upon standing)</li> <li>Oliguria (decreased urine output)</li> <li>Tachycardia (rapid heart rate)</li> <li>Fatigue and weakness</li> <li>Headache</li> <li>Muscle cramps</li> <li>Concentrated urine with high specific gravity</li> <li>Elevated BUN and hematocrit levels</li> <li>Weight loss -Severe cases can progress to hypovolemic shock with cool, clammy skin, altered mental status, oliguria or anuria, and hypotension. Prompt fluid replacement is crucial to prevent complications.</li> </ul> Signup and view all the answers

What are the signs and symptoms of fluid volume excess?

<ul> <li>Weight gain</li> <li>Edema (swelling) in the legs, feet, hands</li> <li>Distended neck veins</li> <li>Shortness of breath</li> <li>Crackles or wheezing in the lungs</li> <li>Jugular venous distension</li> <li>Ascites (fluid accumulation in the abdomen)</li> <li>Increased blood pressure</li> <li>Decreased hematocrit and plasma protein levels - Oliguria (decreased urine output) In severe cases, fluid can accumulate in the lungs causing pulmonary edema with pink, frothy sputum and severe shortness of breath. Fluid overload can also lead to congestive heart failure if the heart cannot handle the increased volume. Prompt treatment with diuretics and fluid restriction is necessary</li> </ul> Signup and view all the answers

Define edema.

-Edema is the accumulation of excessive fluid in the interstitial spaces between cells or body tissues. Signup and view all the answers

What are the main types of edema?

-Localized edema - Swelling confined to a specific area, often due to injury, inflammation or obstruction. -Generalized edema - Widespread swelling throughout the body, often seen in conditions like heart, liver or kidney disease. (called anasarca) -Pitting edema - Edema that leaves an indentation or pit after pressing on the swollen area with a finger. -Non-pitting edema - Firm swelling that does not indent with pressure, seen in conditions like lymphedema. -Peripheral edema - Swelling in the extremities like legs, ankles and feet due to fluid accumulation. -Pulmonary edema - Fluid buildup in the lungs, causing breathing difficulties. -Cerebral edema - Excess fluid in the brain tissue, potentially life-threatening. -Edema can also be classified based on the underlying cause, such as cardiogenic, renal, or lymphatic edema. Signup and view all the answers

Explain the different types of hormonal regulators of fluid intake.

-Hormones regulate fluid intake through various mechanisms: <ul> <li>ADH stored in posterior pituitary gland, release in response to changes in blood osmolarity -Aldosterone released by adrenal cortex, great NA conserver -RAA system to combat hypovolemia</li> </ul> Signup and view all the answers

Briefly discuss the hormonal regulator Antidiuretic hormone (ADH).

<ul> <li>Antidiuretic hormone (ADH) stored in and released from the posterior pituitary gland in response to changes in blood osmolarity. ADH increases water reabsorption by the kidneys.</li> </ul> Signup and view all the answers

Briefly discuss the hormonal regulator Aldosterone.

<ul> <li>Aldosterone released by the adrenal cortex acts as a potent sodium conserver, causing the kidneys to reabsorb more sodium and water.</li> </ul> Signup and view all the answers

Briefly discuss the hormonal regulator the renin-angiotensin-aldosterone (RAA) system.

<ul> <li>The renin-angiotensin-aldosterone (RAA) system combats hypovolemia and low blood pressure by increasing sodium and water retention through angiotensin II and aldosterone effects.</li> </ul> Signup and view all the answers

Briefly discuss the hormonal regulator Atrial natriuretic peptide (ANP).

Atrial natriuretic peptide (ANP) released by the heart. ANP promotes excretion of sodium and water by the kidneys, helping to reduce blood volume and blood pressure. Signup and view all the answers

Explain which organs release the hormonal regulators and how they work in the body.

-Hypothalamus - Produces antidiuretic hormone (ADH) which is stored and released from the posterior pituitary gland. ADH increases water reabsorption by the kidneys. -Kidneys - Specialized cells in the kidneys release renin, which initiates the renin-angiotensin-aldosterone system (RAAS). Renin converts angiotensinogen to angiotensin I, which is further converted to angiotensin II. Angiotensin II stimulates aldosterone release. -Adrenal Cortex - Releases aldosterone in response to angiotensin II. Aldosterone causes the kidneys to reabsorb more sodium and water, increasing blood volume. -Heart Atria - Releases atrial natriuretic peptide (ANP) which counters RAAS by promoting excretion of sodium and water by the kidneys, reducing blood volume. -The integration of these hormones from different organs allows for precise regulation of body fluid levels and blood pressure homeostasis. Signup and view all the answers

Explain fluid and electrolyte diagnostic test evaluation.

-Serum electrolyte tests - Measure sodium, potassium, chloride, bicarbonate levels. Compare to normal ranges to detect imbalances. -Serum hematocrit measures the percentage of red blood cells and can indicate dehydration or overhydration. -Hemoglobin is a protein in red blood cells that carries oxygen. Low levels suggest anemia or fluid imbalance. -BUN (blood urea nitrogen) is a waste product filtered by the kidneys. Elevated levels indicate dehydration or kidney dysfunction. -Creatinine is another waste product eliminated by the kidneys. Rising levels signal impaired kidney function. -Renal function tests like BUN, creatinine, and GFR assess how well the kidneys are filtering wastes and maintaining fluid balance. -Liver function tests like bilirubin, albumin, and clotting factors evaluate the liver's role in fluid regulation and protein production. -Serum osmolality - Measures total solute concentration. Indicates fluid balance. -Urinalysis - Checks for abnormal substances like protein or glucose that can alter fluid balance. -Arterial blood gases - Assess acid-base status, which impacts fluid and electrolyte regulation. -Evaluation: *Assessment and monitoring *Medication *Diet *Fluids *Patient and family education Signup and view all the answers

Explain the medications that can cause electrolyte disturbances.

-Diuretics can cause metabolic alkalosis and hypokalemia (low potassium) or hyperkalemia (high potassium) depending on the type of diuretic. -Steroids like prednisone can lead to metabolic alkalosis. -Potassium supplements may cause gastrointestinal upset, ulcers, or diarrhea if taken in excess. -Respiratory depressants that decrease respiratory rate and depth can result in respiratory acidosis. -Antibiotics: nephrotoxicity, and certain antibiotics like vancomycin can cause hyperkalemia, while others like zosyn (piperacillin/tazobactam) may lead to hypernatremia. -Calcium carbonate antacids can cause mild metabolic alkalosis with nausea and vomiting. -Magnesium hydroxide (milk of magnesia) laxatives can deplete potassium levels, causing hypokalemia. -Stimulant laxatives like dulcolax can disturb fluid and electrolyte balance if overused. Signup and view all the answers

Discuss Diuretics such as Lasix/furosemide.

Diuretics (Lasix/furosemide): Classification: Loop diuretic Action: Increases excretion of sodium, chloride, and water by inhibiting reabsorption in kidney tubules Side effects: Hypokalemia, hyponatremia, dehydration, metabolic alkalosis Nursing diagnosis: Risk for electrolyte imbalance, Deficient fluid volume Interventions: Monitor intake/output, weight, electrolytes. Encourage fluid/electrolyte replacement. Patient teaching: Weigh daily, report excessive thirst/urination. Take potassium supplements as prescribed. Signup and view all the answers

Discuss Steroids, such as Prednisone.

Steroids (Prednisone): Classification: Glucocorticoid Action: Anti-inflammatory, immunosuppressive Side effects: Fluid retention, hypokalemia, hyperglycemia, osteoporosis Nursing diagnosis: Risk for electrolyte imbalance, Impaired glucose tolerance Interventions: Monitor weight, blood glucose, potassium levels. Administer potassium supplements if ordered. Patient teaching: Report swelling, muscle weakness, increased thirst/urination. Follow dietary instructions. Signup and view all the answers

Discuss Antacids such as Calcium carbonate (Tums).

Calcium carbonate (Tums): Classification: Antacid Action: Neutralizes stomach acid Side effects: Constipation, metabolic alkalosis, hypercalcemia Nursing diagnosis: Risk for electrolyte imbalance, Constipation Interventions: Monitor bowel movements, encourage fluids. Check calcium levels. Patient teaching: Take with food/milk to minimize constipation. Report nausea, vomiting, loss of appetite. Signup and view all the answers

Discuss Laxatives such as Kayexalate:

Laxatives (Kayexalate): Classification: Sodium polystyrene sulfonate Action: Binds potassium in intestines for elimination Side effects: Hypokalemia, constipation, intestinal impaction Nursing diagnosis: Risk for electrolyte imbalance, Constipation Interventions: Monitor potassium levels, bowel movements. Encourage fluids. Patient teaching: Take with plenty of water/fluids. Report severe constipation, abdominal pain. Signup and view all the answers

Explain the nurse's assessment related to abnormal electrolyte laboratory values.

-Assessment <ul> <li>Respiratory</li> <li>Circulatory</li> <li>Integumentary -Monitor Intake and Output -Monitor daily weight</li> </ul> -Monitor Laboratory Test <ul> <li>Hypo or hypervolemia</li> <li>Hematocrit</li> <li>BUN</li> <li>Creatinine</li> <li>Urine Specific gravity</li> <li>Serum sodium</li> <li>Serum osmolality Imbalance</li> </ul> -Assessment Medication Cellular regulation Cognition -Communication Perfusion Thermoregulation Elimination Bed position *Semi Fowlers -Monitor fluid intake: Diet -- Fluid restriction -- NPO -- Intake of Sodium Input -- Fluids -- Food Output -- Urine -- Stool -- Sweat Input = Output Signup and view all the answers

Explain the causes of acidosis and alkalosis.

Acidosis can be caused by: *Metabolic causes: - Diabetic ketoacidosis - Lactic acidosis due to poor perfusion - Renal failure leading to acid retention - Ingestion of acidic substances *Respiratory causes: - Hypoventilation and carbon dioxide retention -Alkalosis can be caused by: *Metabolic causes: - Vomiting and loss of hydrochloric acid - Diuretic use - Hypokalemia - Excessive bicarbonate intake *Respiratory causes: - Hyperventilation and excessive carbon dioxide loss Signup and view all the answers

Identify all the signs and symptoms of acidosis.

Headache, lethargy, confusion, coma, Kussmaul respirations (rapid, deep breathing) , Anorexia, nausea, vomiting, diarrhea, abdominal discomfort , Dysrhythmias, hypotension, Muscle weakness, cramping, Fatigue, restlessness Signup and view all the answers

Explain how to calculate and interpret the following types of arterial blood gases: Compensated for acidosis and alkalosis Uncompensated acidosis and alkalosis Partially compensated acidosis and alkalosis

COMPENSATED: PH IS NORMAL -Compensated acidosis: pH is low (7.45), PaCO2 is high, HCO3 is high. The respiratory system has compensated for the metabolic alkalosis by raising PaCO2. 🔹 pH is NORMAL (between 7.35-7.45) 🔹 PaCO₂ and HCO₃⁻ are BOTH abnormal, COMPENSATED: PH IS NORMAL UNCOMPENSATED: PH IS ABNORMAL -Partially compensated acidosis: pH is low but higher than uncompensated, PaCO2 is low but higher than compensated, HCO3 is low. Partial respiratory compensation. 🔹 pH is abnormal (acid low) 🔹 Both PaCO₂ and HCO₃⁻ are abnormal -Partially compensated alkalosis: pH is high but lower than uncompensated, PaCO2 is high but lower than compensated, HCO3 is high. Partial respiratory compensation. 🔹 pH is abnormal (alk high) 🔹 Both PaCO₂ and HCO₃⁻ are abnormal UNCOMPENSATED: PH IS ABNORMAL UNCOMPENSATED: -HCO3- NORMAL RANGE -Uncompensated acidosis: pH is low ( 7.45) 🔹 Only one system (respiratory or metabolic) is abnormal -Uncompensated alkalosis: pH is high (>7.45), PaCO2 is low, HCO3 is high. There is no compensation. -HCO3- NORMAL RANGE 🔹 pH is abnormal (acidic < 7.35 or alkaline > 7.45) 🔹 Only one system (respiratory or metabolic) is abnormal UNCOMPENSATED: HCO3- NORMAL RANGE Signup and view all the answers

Explain the reasons a patient can experience fluid and electrolyte imbalance.

Excessive fluid losses: Vomiting, diarrhea, high output fistulas or drains, excessive sweating, burns, or polyuria can lead to dehydration and electrolyte deficits. -Inadequate fluid intake: Poor oral intake due to nausea, dysphagia, altered mental status, or limited access to fluids. -Kidney disease: Impaired ability to regulate fluid and electrolyte levels. -Endocrine disorders: Conditions like diabetes insipidus, SIADH, Addison's disease, etc. disrupt fluid/electrolyte homeostasis. -Medications: Diuretics, chemotherapy, steroids, and others can cause fluid/electrolyte shifts. -------Severe injuries or illnesses: Major trauma, pancreatitis, sepsis increase fluid/electrolyte needs. -Gastrointestinal losses: Vomiting, diarrhea, fistulas, or ostomy drainage. -Liver disease: Impairs regulation of fluid balance and protein production Signup and view all the answers

Explain the nurse's procedures for determining a patient's fluid balance.

<ol> <li>Measure and record accurate intake and output (I&O) - this includes oral, IV, tube feeding intake, as well as urine output, vomiting, diarrhea, and drainage from tubes/wounds.</li> <li>Weigh the patient daily at the same time using the same scale and clothing. Compare weights day-to-day to detect fluid gains/losses.</li> <li>Assess skin turgor, mucous membranes, and capillary refill for signs of dehydration.</li> <li>Monitor vital signs like blood pressure, pulse, and respiratory rate which can indicate fluid shifts.</li> <li>Review laboratory values like serum electrolytes, BUN, creatinine, and osmolality for imbalances, ABG's</li> <li>Inspect for edema which may signify fluid overload.</li> <li>Collaborate with the healthcare team and patient/family to ensure accurate I&O recording.</li> </ol> Signup and view all the answers

Explain the fluid and electrolyte balance of the older adult health outcomes.

Older adults are at increased risk for fluid and electrolyte imbalances due to physiologic changes that occur with aging. Potential health outcomes include: -Dehydration - Decreased thirst perception, limited mobility, cognitive impairment, and medications like diuretics increase dehydration risk. Dehydration can lead to confusion, constipation, acute kidney injury, and increased risk of falls. -Hypernatremia - Impaired kidney function and hormonal regulation make it difficult to conserve water and dilute sodium. Hypernatremia can cause neurological symptoms like lethargy and seizures. -Hypokalemia - Diuretic use, poor dietary intake, and gastrointestinal losses contribute to low potassium levels. Hypokalemia increases arrhythmia risk and can cause muscle weakness. -Fluid overload - Conditions like heart failure, liver disease, and kidney disease impair fluid regulation. Fluid overload can manifest as peripheral edema, pulmonary edema, and exacerbate underlying conditions. -Careful monitoring of intake/output, daily weights, vital signs, and lab values is crucial to detect and prevent fluid and electrolyte disturbances in the older adult population. Early intervention can help avoid serious complications. Signup and view all the answers

Explain the reason an older adult can develop a fluid deficit and fluid volume excess

-Older adults can develop fluid deficits due to decreased thirst perception, reduced kidney function impairing water conservation, insensible fluid losses, and inadequate fluid intake. Factors like immobility, cognitive impairment, and medication side effects contribute to dehydration risk. -Fluid volume excess can occur in older adults with conditions like heart failure, liver disease, or kidney disease that impair the body's ability to regulate fluid balance. Sodium and water retention leads to edema formation. Careful monitoring of intake, output, weight changes, and clinical signs is crucial to detect and manage fluid imbalances promptly Signup and view all the answers

Explain which system compensates the fastest for altered arterial blood gases.

The RESPIRATORY SYSTEM compensates the fastest for altered arterial blood gases. Signup and view all the answers

Explain the different types of lung sounds

vesicular, crackles (Rales), Rhonchi. Signup and view all the answers

Explain Vesicular Breathe Sounds: (Normal)

Vesicular (Normal) ✅ Soft, low-pitched, rustling sounds Heard over most lung areas Normal breath sounds -Vesicular breath sounds are the normal soft, breezy sounds heard over lung fields during inhalation and exhalation. They indicate air is moving freely through the airways. Signup and view all the answers

Explain Crackles (Rales) Breathe Sounds :(Fluid)

-Crackles (Rales) (Fluid) 💦 Popping, crackling sounds (like rice crispy cereal) Caused by fluid in the lungs (e.g., pneumonia, heart failure) Heard more during inspiration -Crackles (rales) are discontinuous, non-musical, interrupted sounds that can be fine or coarse. Fine crackles sound like hair rubbing together, while coarse crackles are louder, lower-pitched popping sounds. Crackles indicate airway secretions or abnormal opening of small airways. Signup and view all the answers

Explain Rhonchi Breathe Sounds: (Mucus)

-Rhonchi (Mucus) Low-pitched, snoring or gurgling sounds Caused by mucus or secretions in larger airways Clears with coughing (common in bronchitis) -Rhonchi are continuous, low-pitched, snoring or wheezing sounds caused by air moving through obstructed or compressed larger airways. Rhonchi can clear with coughing but often indicate mucus plugging or bronchospasm. Signup and view all the answers

Explain the cause and intervention for pneumothorax, tension thorax, and hemothorax.

-Pneumothorax is caused by air entering the pleural space due to a rupture in the lung (visceral pleura) or chest wall (parietal pleura). Intervention involves inserting a chest tube to remove the air and re-expand the lung. -Tension pneumothorax occurs when air enters the pleural space but cannot escape, increasing pressure and shifting the mediastinum. Emergent decompression with needle thoracostomy or chest tube is required. -Hemothorax is bleeding into the pleural space, often from chest trauma or surgery. A chest tube is inserted to drain the blood and re-expand the lung. Blood products may be needed for significant bleeding. Signup and view all the answers

What are the first signs and symptoms of asthma?

Wheezing Dyspnea Coughing Increased sputum/mucus Increased respiratory rate -SOB -Chest Tightness -rapid breathing, -elevated heart rate -nasal flaring Signup and view all the answers

Flashcards

Intracellular Fluid (ICF)

Fluid inside cells; most of body water.

Extracellular Fluid (ECF)

Fluid outside cells; includes interstitial, intravascular, and transcellular fluids.