Podcast
Questions and Answers
What is the primary solute found in sweat?
What is the primary solute found in sweat?
- Potassium
- Sodium (correct)
- Magnesium
- Calcium
Which of the following factors increase insensible water loss through the skin?
Which of the following factors increase insensible water loss through the skin?
- Fever
- Exercise
- High environmental temperature
- All of the above (correct)
What is the normal range of urine specific gravity?
What is the normal range of urine specific gravity?
- 1.025 to 1.050
- 1.000 to 1.010
- 1.005 to 1.030 (correct)
- 1.015 to 1.040
What is the most reliable indicator of urine concentration?
What is the most reliable indicator of urine concentration?
What is the normal range of serum osmolality?
What is the normal range of serum osmolality?
Which of the following factors can increase serum osmolality?
Which of the following factors can increase serum osmolality?
Which of the following is NOT a factor that can decrease BUN?
Which of the following is NOT a factor that can decrease BUN?
What is the normal range of BUN?
What is the normal range of BUN?
What is the better indicator of renal function, BUN or creatinine?
What is the better indicator of renal function, BUN or creatinine?
What is the normal range of serum creatinine?
What is the normal range of serum creatinine?
Which of the following conditions can increase BUN?
Which of the following conditions can increase BUN?
What is the daily average intake and output of water in healthy people?
What is the daily average intake and output of water in healthy people?
What is insensible water loss?
What is insensible water loss?
What is the approximate daily fluid loss through the gastrointestinal tract?
What is the approximate daily fluid loss through the gastrointestinal tract?
What is the primary factor that determines serum osmolality?
What is the primary factor that determines serum osmolality?
What is the normal daily urine output for a well-hydrated adult?
What is the normal daily urine output for a well-hydrated adult?
What is the term for the accumulation of fluid in membrane-bound spaces within the body, such as the peritoneal cavity?
What is the term for the accumulation of fluid in membrane-bound spaces within the body, such as the peritoneal cavity?
What is the primary difference between osmolality and osmolarity?
What is the primary difference between osmolality and osmolarity?
Which of the following electrolytes is the most abundant cation in the extracellular fluid (ECF)?
Which of the following electrolytes is the most abundant cation in the extracellular fluid (ECF)?
Which of the following is a potential consequence of a third-space fluid shift?
Which of the following is a potential consequence of a third-space fluid shift?
What is the primary force that pushes fluid out of the capillary into the tissues?
What is the primary force that pushes fluid out of the capillary into the tissues?
Which of the following is NOT a sign or symptom of third-space fluid shift?
Which of the following is NOT a sign or symptom of third-space fluid shift?
What is the primary function of the sodium-potassium pump?
What is the primary function of the sodium-potassium pump?
What is the term for the pressure exerted by the solutes within the plasma?
What is the term for the pressure exerted by the solutes within the plasma?
Which of the following is a major anion in the body fluids?
Which of the following is a major anion in the body fluids?
Why does the release of large stores of intracellular potassium pose a significant danger?
Why does the release of large stores of intracellular potassium pose a significant danger?
What is the primary mechanism by which fluid shifts from the region of a less concentrated solution to a more concentrated solution?
What is the primary mechanism by which fluid shifts from the region of a less concentrated solution to a more concentrated solution?
Which of the following conditions is characterized by fluid accumulation in the pleural space?
Which of the following conditions is characterized by fluid accumulation in the pleural space?
What is the primary difference between hydrostatic pressure and osmotic pressure?
What is the primary difference between hydrostatic pressure and osmotic pressure?
What is the term for the pressure exerted by albumin in the bloodstream?
What is the term for the pressure exerted by albumin in the bloodstream?
Why is electrolyte concentration expressed in milliequivalents (mEq) per liter rather than milligrams (mg)?
Why is electrolyte concentration expressed in milliequivalents (mEq) per liter rather than milligrams (mg)?
Which of the following situations is most likely to cause cell swelling?
Which of the following situations is most likely to cause cell swelling?
What is the normal BUN to serum creatinine concentration ratio?
What is the normal BUN to serum creatinine concentration ratio?
Which of the following is NOT a cause of FVD?
Which of the following is NOT a cause of FVD?
What is the clinical manifestation of decreased plasma volume that leads to an increase in concentration of RBCs?
What is the clinical manifestation of decreased plasma volume that leads to an increase in concentration of RBCs?
Which of the following is TRUE regarding FVD?
Which of the following is TRUE regarding FVD?
What is the major regulator of potassium in the body?
What is the major regulator of potassium in the body?
Which of the following conditions can lead to hyperkalemia?
Which of the following conditions can lead to hyperkalemia?
What is the role of aldosterone in FVD?
What is the role of aldosterone in FVD?
What is the minimum urine output per day in an adult?
What is the minimum urine output per day in an adult?
Which of the following is a sign of FVD?
Which of the following is a sign of FVD?
Which of the following is NOT a gerontological consideration related to fluid balance?
Which of the following is NOT a gerontological consideration related to fluid balance?
Which of the following is NOT a characteristic of crystalloid solutions?
Which of the following is NOT a characteristic of crystalloid solutions?
What is the primary concern when preventing dehydration in older adults?
What is the primary concern when preventing dehydration in older adults?
How does dehydration in older adults affect the skin?
How does dehydration in older adults affect the skin?
In which scenario would a patient with FVD have a BUN to serum creatinine ratio greater than 20:1?
In which scenario would a patient with FVD have a BUN to serum creatinine ratio greater than 20:1?
Which type of solution would be most appropriate for treating a patient with severe edema?
Which type of solution would be most appropriate for treating a patient with severe edema?
How does aldosterone affect urine osmolality?
How does aldosterone affect urine osmolality?
What is the primary mechanism by which mannitol reduces cerebral edema?
What is the primary mechanism by which mannitol reduces cerebral edema?
What is the primary mechanism behind dehydration in older adults?
What is the primary mechanism behind dehydration in older adults?
What is the primary driving force behind diffusion?
What is the primary driving force behind diffusion?
Which of the following is NOT an example of diffusion?
Which of the following is NOT an example of diffusion?
What is the primary role of hydrostatic pressure in the capillaries?
What is the primary role of hydrostatic pressure in the capillaries?
Which of the following statements about osmotic diuresis is TRUE?
Which of the following statements about osmotic diuresis is TRUE?
Which of the following BEST describes the difference between crystalloid and colloid solutions?
Which of the following BEST describes the difference between crystalloid and colloid solutions?
Which of the following is a CORRECT statement about isotonic solutions?
Which of the following is a CORRECT statement about isotonic solutions?
What is the primary function of tonicity in the body?
What is the primary function of tonicity in the body?
Which of the following is NOT a key component of blood?
Which of the following is NOT a key component of blood?
Which of the following statements is TRUE regarding hypotonic solutions?
Which of the following statements is TRUE regarding hypotonic solutions?
Which of the following is a CORRECT statement about active transport?
Which of the following is a CORRECT statement about active transport?
Which of the following BEST describes the role of the kidneys in fluid balance?
Which of the following BEST describes the role of the kidneys in fluid balance?
What is the primary difference between filtration and diffusion?
What is the primary difference between filtration and diffusion?
Which of the following is NOT considered a transcellular fluid?
Which of the following is NOT considered a transcellular fluid?
What percentage of a typical adult's body weight is composed of fluid?
What percentage of a typical adult's body weight is composed of fluid?
Which of the following factors does NOT influence the amount of body fluid in an individual?
Which of the following factors does NOT influence the amount of body fluid in an individual?
What is the approximate volume of plasma in the average adult?
What is the approximate volume of plasma in the average adult?
What is the largest fluid compartment in the body?
What is the largest fluid compartment in the body?
What type of membrane allows certain fluids and electrolytes to move between the intracellular and extracellular spaces?
What type of membrane allows certain fluids and electrolytes to move between the intracellular and extracellular spaces?
What is the term for severe generalized edema?
What is the term for severe generalized edema?
Which of the following is NOT a component of blood plasma?
Which of the following is NOT a component of blood plasma?
What is the main function of the extracellular fluid?
What is the main function of the extracellular fluid?
Which of the following conditions can contribute to increased interstitial fluid volume?
Which of the following conditions can contribute to increased interstitial fluid volume?
Which medication class is often associated with causing edema?
Which medication class is often associated with causing edema?
What is a common cause of sodium retention that may lead to increased extracellular fluid volume?
What is a common cause of sodium retention that may lead to increased extracellular fluid volume?
Which symptom might a patient with ascites experience?
Which symptom might a patient with ascites experience?
What condition can cause localized edema in the ankle?
What condition can cause localized edema in the ankle?
How does decreased cardiac output contribute to edema?
How does decreased cardiac output contribute to edema?
Which treatment is NOT typically used for managing edema?
Which treatment is NOT typically used for managing edema?
Which therapy is commonly used for the removal of nitrogenous wastes in patients with severe renal impairment?
Which therapy is commonly used for the removal of nitrogenous wastes in patients with severe renal impairment?
What is the typical sodium restriction in a low sodium diet for patients with FVE?
What is the typical sodium restriction in a low sodium diet for patients with FVE?
What does the presence of pitting edema indicate in a patient?
What does the presence of pitting edema indicate in a patient?
Which of the following substitutes can be used to reduce sodium intake?
Which of the following substitutes can be used to reduce sodium intake?
What is the recommended action for patients using potassium-sparing diuretics when considering salt substitutes?
What is the recommended action for patients using potassium-sparing diuretics when considering salt substitutes?
A weight gain of 1 kg is indicative of what amount of fluid retention?
A weight gain of 1 kg is indicative of what amount of fluid retention?
What is a common dietary recommendation for managing fluid volume excess?
What is a common dietary recommendation for managing fluid volume excess?
Which of the following actions may help reduce fluid retention in FVE patients?
Which of the following actions may help reduce fluid retention in FVE patients?
What specific risk do patients with liver damage face when using certain salt substitutes?
What specific risk do patients with liver damage face when using certain salt substitutes?
Why is monitoring I&O important in patients with FVE?
Why is monitoring I&O important in patients with FVE?
What type of water may be necessary for patients on a strict sodium-restricted diet?
What type of water may be necessary for patients on a strict sodium-restricted diet?
What is the significance of monitoring the size of the extremity in patients with peripheral edema?
What is the significance of monitoring the size of the extremity in patients with peripheral edema?
In patients with FVE, why might a nurse position the patient in a semi-Fowler position?
In patients with FVE, why might a nurse position the patient in a semi-Fowler position?
What should patients on sodium-restricted diets be cautious of when taking OTC medications?
What should patients on sodium-restricted diets be cautious of when taking OTC medications?
What is the primary function of diuretics in managing fluid volume excess (FVE)?
What is the primary function of diuretics in managing fluid volume excess (FVE)?
In the context of preventing fluid volume deficits (FVD), which action should a nurse take for a patient experiencing diarrhea?
In the context of preventing fluid volume deficits (FVD), which action should a nurse take for a patient experiencing diarrhea?
Which electrolyte imbalance is most likely to occur with diuretics that inhibit aldosterone?
Which electrolyte imbalance is most likely to occur with diuretics that inhibit aldosterone?
What is a common clinical manifestation of fluid volume excess (FVE)?
What is a common clinical manifestation of fluid volume excess (FVE)?
How does excessive administration of sodium-containing fluids contribute to FVE?
How does excessive administration of sodium-containing fluids contribute to FVE?
What is a possible laboratory finding in a patient with FVE?
What is a possible laboratory finding in a patient with FVE?
Why might a patient with oral discomfort be reluctant to drink fluids for rehydration?
Why might a patient with oral discomfort be reluctant to drink fluids for rehydration?
Which type of diuretic is typically prescribed for mild to moderate hypervolemia?
Which type of diuretic is typically prescribed for mild to moderate hypervolemia?
What does the accumulation of aldosterone in patients with conditions like cirrhosis cause?
What does the accumulation of aldosterone in patients with conditions like cirrhosis cause?
What condition is most commonly associated with hypervolemia due to renal dysfunction?
What condition is most commonly associated with hypervolemia due to renal dysfunction?
Which of the following fluids is likely to be most effective in replacing lost electrolytes during diarrhea?
Which of the following fluids is likely to be most effective in replacing lost electrolytes during diarrhea?
What assessment finding is commonly seen in patients who are supine with FVE?
What assessment finding is commonly seen in patients who are supine with FVE?
What is a significant risk associated with the use of both thiazide and loop diuretics?
What is a significant risk associated with the use of both thiazide and loop diuretics?
Which factor may lead to diminished function of homeostatic mechanisms regulating fluid balance?
Which factor may lead to diminished function of homeostatic mechanisms regulating fluid balance?
Which of these conditions is NOT directly related to the level of hematocrit?
Which of these conditions is NOT directly related to the level of hematocrit?
What is the primary function of the kidneys in maintaining fluid balance?
What is the primary function of the kidneys in maintaining fluid balance?
What is the role of the pituitary gland in fluid balance?
What is the role of the pituitary gland in fluid balance?
Which of these factors can contribute to an increase in insensible water loss?
Which of these factors can contribute to an increase in insensible water loss?
What is the function of baroreceptors in fluid balance?
What is the function of baroreceptors in fluid balance?
How does the renin-angiotensin-aldosterone system (RAAS) contribute to fluid balance?
How does the renin-angiotensin-aldosterone system (RAAS) contribute to fluid balance?
What is the normal range for urine sodium levels in a 24-hour period?
What is the normal range for urine sodium levels in a 24-hour period?
Which condition can cause a decrease in hematocrit?
Which condition can cause a decrease in hematocrit?
What organ is NOT directly involved in maintaining fluid balance?
What organ is NOT directly involved in maintaining fluid balance?
Which of the following hormones directly influences calcium reabsorption in the kidneys?
Which of the following hormones directly influences calcium reabsorption in the kidneys?
How does the heart contribute to renal perfusion and fluid balance?
How does the heart contribute to renal perfusion and fluid balance?
Which of these conditions is characterized by an abnormally high number of red blood cells in the bloodstream?
Which of these conditions is characterized by an abnormally high number of red blood cells in the bloodstream?
What is the primary function of aldosterone in fluid balance?
What is the primary function of aldosterone in fluid balance?
What is the main function of the lungs in acid-base balance?
What is the main function of the lungs in acid-base balance?
What is the normal range for hematocrit in men?
What is the normal range for hematocrit in men?
Which of the following processes contributes to the regulation of ECF volume?
Which of the following processes contributes to the regulation of ECF volume?
Which of the following is NOT a factor that can influence fluid needs in a patient with fluid volume deficit (FVD)?
Which of the following is NOT a factor that can influence fluid needs in a patient with fluid volume deficit (FVD)?
What is the primary reason isotonic electrolyte crystalloids are often the first-line treatment for hypotensive patients with FVD?
What is the primary reason isotonic electrolyte crystalloids are often the first-line treatment for hypotensive patients with FVD?
When would a hypotonic electrolyte solution be used in a patient with FVD?
When would a hypotonic electrolyte solution be used in a patient with FVD?
Which vital sign is most indicative of hypovolemia in a patient with relatively normal cardiopulmonary function?
Which vital sign is most indicative of hypovolemia in a patient with relatively normal cardiopulmonary function?
During a fluid challenge test, monitoring which parameter is NOT typically considered?
During a fluid challenge test, monitoring which parameter is NOT typically considered?
Which of the following is a typical example of a fluid challenge test?
Which of the following is a typical example of a fluid challenge test?
What is the primary goal of a fluid challenge test?
What is the primary goal of a fluid challenge test?
What is considered a healthy renal response in a patient with FVD?
What is considered a healthy renal response in a patient with FVD?
Which of the following is NOT a clinical manifestation of FVD?
Which of the following is NOT a clinical manifestation of FVD?
Which assessment finding would be most suggestive of severe FVD?
Which assessment finding would be most suggestive of severe FVD?
What is the recommended frequency for monitoring fluid intake and output in a patient with FVD?
What is the recommended frequency for monitoring fluid intake and output in a patient with FVD?
What is the significance of a weight loss of 0.5 kg (1.1 lb) in a day?
What is the significance of a weight loss of 0.5 kg (1.1 lb) in a day?
What is the most common reason for increased urination (polyuria) that contributes to FVD?
What is the most common reason for increased urination (polyuria) that contributes to FVD?
Which of the following is NOT a typical assessment finding in a patient with FVD?
Which of the following is NOT a typical assessment finding in a patient with FVD?
Which of the following is true regarding tissue turgor in older adults?
Which of the following is true regarding tissue turgor in older adults?
Which of the following factors can contribute to FVD in hospitalized, critically ill patients?
Which of the following factors can contribute to FVD in hospitalized, critically ill patients?
Which of the following substances is responsible for increasing sodium and water reabsorption at the nephron, ultimately raising blood volume and blood pressure?
Which of the following substances is responsible for increasing sodium and water reabsorption at the nephron, ultimately raising blood volume and blood pressure?
What is the primary function of natriuretic peptides in fluid volume and cardiovascular regulation?
What is the primary function of natriuretic peptides in fluid volume and cardiovascular regulation?
How does ADH contribute to maintaining fluid balance in the body?
How does ADH contribute to maintaining fluid balance in the body?
Which of the following is NOT a typical symptom of dehydration?
Which of the following is NOT a typical symptom of dehydration?
Which of the following statements accurately describes the role of osmoreceptors in fluid balance?
Which of the following statements accurately describes the role of osmoreceptors in fluid balance?
What are the two major hormones involved in the regulation of blood pressure through the renin-angiotensin-aldosterone system?
What are the two major hormones involved in the regulation of blood pressure through the renin-angiotensin-aldosterone system?
What are the primary physiological changes associated with aging that can influence fluid and electrolyte balance?
What are the primary physiological changes associated with aging that can influence fluid and electrolyte balance?
What is the primary function of angiotensin-converting enzyme (ACE)?
What is the primary function of angiotensin-converting enzyme (ACE)?
Which of the following statements best describes the relationship between natriuretic peptides and the renin-angiotensin-aldosterone system?
Which of the following statements best describes the relationship between natriuretic peptides and the renin-angiotensin-aldosterone system?
Which of the following describes a consequence of the decrease in muscle mass seen with aging?
Which of the following describes a consequence of the decrease in muscle mass seen with aging?
Which of the following is NOT a type of natriuretic peptide?
Which of the following is NOT a type of natriuretic peptide?
What effect does an increase in serum osmolality have on thirst and ADH release?
What effect does an increase in serum osmolality have on thirst and ADH release?
What is the main reason why older adults are more susceptible to fluid and electrolyte disturbances?
What is the main reason why older adults are more susceptible to fluid and electrolyte disturbances?
What is the main difference between BNP and NT-pro BNP?
What is the main difference between BNP and NT-pro BNP?
How does the body compensate for the decreased renal function that occurs with aging?
How does the body compensate for the decreased renal function that occurs with aging?
What is the primary role of the thirst center in maintaining fluid balance?
What is the primary role of the thirst center in maintaining fluid balance?
Flashcards
Solution
Solution
A mixture of solvent (fluid) and solutes (particles).
Plasma
Plasma
The liquid component of blood, consisting of about 92% water and contains solutes.
Body Fluid Composition
Body Fluid Composition
Approximately 60% of an adult’s weight is fluid made up of water and electrolytes.
Intracellular Fluid (ICF)
Intracellular Fluid (ICF)
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Extracellular Fluid (ECF)
Extracellular Fluid (ECF)
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Intravascular Space
Intravascular Space
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Interstitial Fluid
Interstitial Fluid
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Transcellular Fluid
Transcellular Fluid
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Fluid balance
Fluid balance
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ICF
ICF
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ECF
ECF
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Cellular dehydration
Cellular dehydration
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Cell swelling
Cell swelling
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Third-space fluid shift
Third-space fluid shift
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Signs of third-spacing
Signs of third-spacing
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Electrolytes
Electrolytes
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Milliequivalents (mEq)
Milliequivalents (mEq)
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Sodium's role
Sodium's role
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Potassium's importance
Potassium's importance
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Osmosis
Osmosis
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Osmolality vs. osmolarity
Osmolality vs. osmolarity
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Hydrostatic pressure
Hydrostatic pressure
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Colloid oncotic pressure
Colloid oncotic pressure
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Crystalloid Solutions
Crystalloid Solutions
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Colloid Solutions
Colloid Solutions
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Tonicity
Tonicity
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Isotonic Solutions
Isotonic Solutions
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Hypotonic Solutions
Hypotonic Solutions
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Hypertonic Solutions
Hypertonic Solutions
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Osmotic Diuresis
Osmotic Diuresis
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Diffusion
Diffusion
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Filtration
Filtration
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Sodium-Potassium Pump
Sodium-Potassium Pump
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Active Transport
Active Transport
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Daily Fluid Intake
Daily Fluid Intake
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Urine Output
Urine Output
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Perspiration
Perspiration
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Insensible Water Loss
Insensible Water Loss
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Fluid Loss from Lungs
Fluid Loss from Lungs
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Gastrointestinal Fluid Loss
Gastrointestinal Fluid Loss
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Serum Osmolality
Serum Osmolality
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Urine Osmolality
Urine Osmolality
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Urine Specific Gravity
Urine Specific Gravity
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Blood Urea Nitrogen (BUN)
Blood Urea Nitrogen (BUN)
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Creatinine
Creatinine
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Kidney Function Assessment
Kidney Function Assessment
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Fluid Reabsorption
Fluid Reabsorption
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Sweat Composition
Sweat Composition
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Factors Decreasing BUN
Factors Decreasing BUN
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Hematocrit
Hematocrit
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Normal Hematocrit Range
Normal Hematocrit Range
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Polycythemia
Polycythemia
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Dehydration Effects on Hematocrit
Dehydration Effects on Hematocrit
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Overhydration Effects on Hematocrit
Overhydration Effects on Hematocrit
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Anemia
Anemia
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Normal Urine Sodium Levels
Normal Urine Sodium Levels
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Kidney Functions
Kidney Functions
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ADH Function
ADH Function
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Aldosterone
Aldosterone
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Baroreceptors
Baroreceptors
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Renin-Angiotensin-Aldosterone System
Renin-Angiotensin-Aldosterone System
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Lung Functions in Homeostasis
Lung Functions in Homeostasis
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Pituitary Gland Role
Pituitary Gland Role
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Kidney Regulation of ECF
Kidney Regulation of ECF
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Dehydration in older adults
Dehydration in older adults
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Hypovolemia (FVD)
Hypovolemia (FVD)
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ECF Volume Loss
ECF Volume Loss
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Fluid Volume Deficiency Causes
Fluid Volume Deficiency Causes
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Diabetes insipidus
Diabetes insipidus
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BUN to Creatinine Ratio
BUN to Creatinine Ratio
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Hematocrit in Hypovolemia
Hematocrit in Hypovolemia
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Oliguria
Oliguria
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Hyperkalemia causes
Hyperkalemia causes
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Hyponatremia causes
Hyponatremia causes
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Skin turgor assessment
Skin turgor assessment
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Functional assessment for fluids
Functional assessment for fluids
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Fluid intake in elderly
Fluid intake in elderly
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Edema
Edema
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Localized edema
Localized edema
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Generalized edema
Generalized edema
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Anasarca
Anasarca
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Ascites
Ascites
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Sodium retention
Sodium retention
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Diuretic therapy
Diuretic therapy
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Fluid Volume Deficit (FVD)
Fluid Volume Deficit (FVD)
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Oral Hydration
Oral Hydration
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Intravenous (IV) Route
Intravenous (IV) Route
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Fluid Challenge Test
Fluid Challenge Test
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Urine Output Monitoring
Urine Output Monitoring
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Tongue Turgor
Tongue Turgor
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Daily Weight Monitoring
Daily Weight Monitoring
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Vital Signs Monitoring
Vital Signs Monitoring
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Cold Extremities
Cold Extremities
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Oliguric Condition
Oliguric Condition
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Central Venous Pressure (CVP)
Central Venous Pressure (CVP)
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Signs of FVD
Signs of FVD
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Antidiarrheal Medications
Antidiarrheal Medications
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Oral Rehydration Solutions
Oral Rehydration Solutions
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Hypervolemia
Hypervolemia
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Causes of Hypervolemia
Causes of Hypervolemia
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Clinical Manifestations of FVE
Clinical Manifestations of FVE
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BUN & Hematocrit in FVE
BUN & Hematocrit in FVE
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Role of Diuretics
Role of Diuretics
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Thiazide Diuretics
Thiazide Diuretics
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Loop Diuretics
Loop Diuretics
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Potassium-Sparing Diuretics
Potassium-Sparing Diuretics
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Hyponatremia in Diuresis
Hyponatremia in Diuresis
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Azotemia
Azotemia
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Electrolyte Imbalances from Diuretics
Electrolyte Imbalances from Diuretics
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Dialysis
Dialysis
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Hemodialysis
Hemodialysis
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Peritoneal Dialysis
Peritoneal Dialysis
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Continuous Renal Replacement Therapy
Continuous Renal Replacement Therapy
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Sodium Restriction
Sodium Restriction
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FVE (Fluid Volume Excess)
FVE (Fluid Volume Excess)
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Pitting Edema
Pitting Edema
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Sodium Chloride
Sodium Chloride
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Nutritional Therapy for FVE
Nutritional Therapy for FVE
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Weight Gain Indicator
Weight Gain Indicator
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Salt Substitutes
Salt Substitutes
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Parenteral Fluid Therapy
Parenteral Fluid Therapy
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Monitoring Edema
Monitoring Edema
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Cautious Potassium Use
Cautious Potassium Use
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Patient Education on Edema
Patient Education on Edema
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Renin
Renin
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Angiotensin I
Angiotensin I
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Angiotensin II
Angiotensin II
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Antidiuretic Hormone (ADH)
Antidiuretic Hormone (ADH)
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Thirst Mechanism
Thirst Mechanism
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Osmoreceptors
Osmoreceptors
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Natriuretic Peptides
Natriuretic Peptides
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Atrial Natriuretic Peptide (ANP)
Atrial Natriuretic Peptide (ANP)
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Brain Natriuretic Peptide (BNP)
Brain Natriuretic Peptide (BNP)
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Dehydration
Dehydration
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Older Adult Considerations
Older Adult Considerations
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Study Notes
Fluid and Electrolyte Balance
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Body fluids comprise approximately 60% of an adult's weight, with distribution influenced by age, gender, and body fat.
- Younger individuals and men have a higher percentage of body fluid compared to older adults and women.
- Muscle, skin, and blood contain the highest amounts of water.
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Fluid compartments include intracellular fluid (ICF) and extracellular fluid (ECF).
- About two-thirds of body fluid is ICF, and one-third is ECF.
- ECF further divides into intravascular (plasma), interstitial, and transcellular fluid spaces.
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Intravascular fluid (plasma) constitutes approximately 3 liters of the average 6 liters of blood volume in adults.
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Interstitial fluid surrounds cells and totals about 11-12 liters in adults.
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Transcellular fluid includes cerebrospinal, pericardial, synovial, intraocular, and pleural fluids, sweat, and digestive secretions; about 1 liter.
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The body maintains equilibrium between ICF and ECF, but disturbances can lead to cellular dehydration or swelling.
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Third-space fluid shift occurs when fluid is unavailable to contribute to ICF-ECF equilibrium; it accumulates within membrane-bound spaces.
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Loss of ECF can cause decreased urine output, increased heart rate, decreased blood pressure, and other signs.
Electrolytes
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Electrolytes are active chemicals (cations and anions) important in maintaining body fluid balance.
- Major cations are sodium, potassium, calcium, magnesium, and hydrogen ions.
- Major anions are chloride, bicarbonate, phosphate, sulfate, and negatively charged protein ions.
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Electrolyte concentrations are expressed in milliequivalents per liter (mEq/L) to measure chemical activity.
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ICF and ECF electrolyte concentrations differ significantly.
- Sodium is the most abundant cation in ECF, regulating ECF volume.
- Potassium is a major electrolyte in ICF and crucial for cardiac function; small changes can be dangerous.
Osmosis, Osmolality, and Osmolarity
- Osmosis is the movement of fluid from a less concentrated solution to a more concentrated one across a semipermeable membrane until equal solute concentrations are attained.
- Osmolality is the solute concentration per kilogram of solvent, expressed in milliosmoles per kilogram (mOsm/kg).
- Osmolarity is the solute concentration per liter of solution, expressed in milliosmoles per liter (mOsm/L).
- Starling's Laws of Capillary Forces relate hydrostatic pressure (pushing fluid out) and osmotic pressure (pulling fluid in) at capillary membranes to facilitate fluid exchange.
- Colloid oncotic pressure is osmotic pressure exerted by albumin in the bloodstream.
Crystalloids versus Colloids
- Crystalloid solutions are mineral ions dissolved in water (e.g., normal saline, lactated Ringer's).
- Colloid solutions contain large solute particles (e.g., albumin solutions, hyperoncotic starch).
Tonicity
- Tonicity refers to a solution's ability to cause water movement.
- Isotonic solutions (e.g., 0.9% NaCl) have the same solute concentration as body fluids, preventing water shifts.
- Hypotonic solutions (e.g., 0.45% NaCl) have lower solute concentration, causing water to move into cells.
- Hypertonic solutions (e.g., 3% NaCl) have higher solute concentration, causing water to move out of cells.
Diuresis and Diffusion
- Osmotic diuresis is increased urine output caused by solute excretion (e.g., glucose, mannitol).
- Diffusion is the movement of a substance from an area of higher to lower concentration.
Filtration
- Hydrostatic pressure in capillaries forces fluid out into interstitial fluid.
- The kidneys filter approximately 180 L of plasma daily.
Membrane Potential and Pumps
- The sodium-potassium pump actively maintains differing ion concentrations across cell membranes.
- Exchanges 3 sodium ions for 2 potassium ions, using ATP.
Systemic Fluid Gains and Losses
- Daily water intake and output are approximately equal in healthy individuals.
- Kidneys: Urine output varies based on hydration, typically 1-2 liters per day.
- Skin: Insensible water loss (perspiration) can range from 0 to 1000 mL+ per hour.
- Lungs: Insensible water loss through respiration is approximately 300 mL per day.
- Gastrointestinal Tract: Fluid loss is typically 100-200 mL per day.
Laboratory Tests
- Serum osmolality reflects sodium concentration, with normal range of 275-290 mOsm/kg.
- Urine osmolality, a more reliable indicator than specific gravity, helps evaluate urine concentration.
- BUN (blood urea nitrogen) measures urea levels and is affected by renal function, protein intake, and hydration.
- Creatinine measures muscle metabolism and provides a more consistent assessment of renal function.
- Hematocrit is the percentage of red blood cells in blood.
- Urine sodium, measured over 24 hours or in a random specimen, assesses fluid volume status.
Homeostatic Mechanisms
- Kidneys, heart, lungs, pituitary, adrenal, and parathyroid glands maintain fluid and electrolyte balance.
- Kidney functions include fluid/electrolyte regulation, pH control, and waste removal.
- Heart and lungs circulate blood, remove water vapor and support acid-base balance.
- Pituitary releases ADH, affecting water reabsorption.
- Adrenals secrete aldosterone, regulating sodium and potassium levels.
- Parathyroids regulate calcium and phosphate balance.
- Baroreceptors detect blood pressure changes, triggering compensatory responses.
- Renin-angiotensin-aldosterone system adjusts blood pressure and fluid balance.
Natriuretic Peptides
- Natriuretic peptides (ANP, BNP, NT-pro BNP) oppose the renin-angiotensin-aldosterone system to regulate fluid volume and blood pressure.
Gerontologic Considerations
- Normal aging leads to decreased cardiac, renal, and respiratory function, affecting fluid and electrolyte balance.
- Medications can interact, increasing risk for imbalances in older adults.
Hypovolemia (Fluid Volume Deficit)
- Hypovolemia occurs when ECF volume loss exceeds intake, often due to vomiting, diarrhea, or third-space fluid shifts.
- Signs include decreased urine output, increased heart rate, decreased blood pressure, altered skin turgor, reduced central venous pressure, and confusion.
- Increased BUN/creatinine ratio is a potential lab finding, while hematocrit is elevated.
- Management involves replacing fluids, often intravenously with isotonic solutions.
Hypervolemia (Fluid Volume Excess)
- Hypervolemia occurs when water and sodium retention cause ECF expansion.
- Signs/Symptoms include edema, distended jugular veins, crackles in lungs and weight gain.
- Lower BUN and hematocrit, resulting from plasma dilution, are likely lab findings.
- Management often includes diuretics and sodium restriction.
Nursing Management
- Nurses monitor fluid intake and output, vital signs, weight, and edema for both hypo and hypervolemia.
- Careful consideration of geriatric patients is needed due to possible subtle presentations, altered responses to treatment, and potential for rapid changes in conditions.
- Oral fluid replacement is preferred when possible.
- Accurate intake and output recording is critical.
- Monitoring of mental status, as well as other associated symptoms like skin turgor and peripheral perfusion is key.
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