Fluid Overload Exam Questions and Correct Answers (Graded A+)

Fluid Overload Exam Questions and Correct Answers (Graded A+) fluid compartments in body - Answers intracellular-inside cell extracellular-outside cell in 3 compartments interstitial fluid - Answers fluid in the spaces between cells-third space intravascular fluid - Answers fluid within blood vessels plasma lymph fluid - Answers fluid that circulates through the body in lymph vessels and eventually enters the bloodstream insensible water loss - Answers the loss of water not noticeable by a person, such as through evaporation from the skin and exhalation from the lungs during breathing normal kidney output - Answers 30 mL/hr 0.5mL/kg/hr 1 liter water - Answers 2.2lbs or 1 kg blood osmolarity - Answers 275mOsm/kg - 295mOsm/kg An increase can result from dehydration - think -high and dry A decrease can result from fluid overload or excessive intravascular fluid - think low - below Below sea level, therefore wet. regulators blood osmolarity - Answers Hypothalamus monitors osmotic pressure (ratio of solute particles to solvent water/fluid) an increase in osmotic pressure leads to thirst ADH -reabsorbs water from the filtrate (urine) in the kidneys keeping the fluid in the body decreasing osmotic pressure Aldosterone-reabsorbs Na+ from the filtrate (urine) keeping the Na+ in the body increasing the osmotic pressure (remember aldosterone and cortisol are steroids so when a client is on steroids they may retain Na+ and become hypernatremic) Water follows Na+ so ↑ in Na+ re-absorption in kidneys = ↑ water re-absorption as well. isotonic solutions - Answers of the same concentration 5% Glucose 0 .9% NaCl LR - Lactated Ringers hypotonic solutions - Answers of below concentration WATER, 0. 45% NaCl, hypertonic solutions - Answers of above concentration 50% Glucose, 3% normal saline . BUN - Answers BUN 10-20 mg/dl Normal Creatinine 0.6-1.3 mg/dl Increase in Blood urea nitrogen (BUN) means an increase in protein metabolism which could be due to crushing injuries, burns, or other traumas. An increase in serum creatinine would reflect a decrease in kidney function. Urine becomes closer to plasma and the influence of diet will be seen to have a more direct affect on the urine. Sodium - Answers + 135 -145 mEq/L Function: Most abundant extracellular ion. Function in the generation of action potential in skeletal muscle and nervous tissue. Maintains osmotic pressure of the ECF. Amount of Na+ regulates water balance and blood pressure. Controlled by ADH, aldosterone, and ANP (atrial naturetic peptide). Foods high in sodium: processed/canned, broth, vegetable juices, and celery hyponatremia - Answers Cause: Loss of NA+ through sweat, vomiting, diarrhea, diuretic or burns. True excess of water as in SIADH or renal failure. Also seen in when cells begin to lyse increasing extracellular K+. Excess of dextrose IV solutions or fluid replacement with water (ice chips). Symptoms: Weight gain, muscle weakness, tachycardia but weak pulse & shock. Mental confusion and anxiety due to increase water in CNS, (Brain cells swell) stupor and coma may result Hypernatremia - Answers Cause: Increase in Na+ in the ECF due to dehydration or decrease of water intake. Also Na+ gain in diet, medication or through IV solution. Caused by polyuria such as with Diabetes mellitus, also seen in burns, and in Cushing disease. Osmotic diuretics and mechanical ventilation may lead to H2O loss without Na+ loss. Symptoms: Intense thirst, poor skin turgor, overall weakness, and lethargy. Finally renal failure or coma may result from to cellular dehydration. (Brain cells shrink) Potassium - Answers 3.5-5.0 mEq/L Function: Most abundant intracellular ion needed for the repolarization of action potential in skeletal muscle and nervous tissue, also maintains osmotic pressure. Helps in the pH balance. Controls blood pressure through the secretion of aldosterone (Increase of K+ leads to increase of Aldosterone). NOTE: K+ is not stored by the body; freely excreted by kidneys Foods High in K+: bananas, pears, potatoes, tea, colas and fruit juices. Never give more than 40MEq of KCl/L Intravenously! hypokalemia - Answers Cause: Increase of Na+, vomiting, diarrhea, use of some diuretics, IV insulin or glucose, and kidney disease. Also seen in cases of excessive Aldosterone as in adrenal tumor or Cushing's disease. Symptoms: Muscular weakness, increased urine output, depressed respirations, vomiting and coma. Depresses reflexes and blood pressure. Cardiac dysrhythmias such as bradycardia, AV block Decreased T wave and prolonged QRS. Note: will enhance the effects of Digitalis and may cause toxicity. hyperkalemia - Answers Cause: Increase of K+ in the blood due to cellular traumas in burns and MI. Also seen Addison's disease, insulin deficiency, hemorrhagic shock and intestinal obstruction. Symptoms: Muscular weakness, respiratory difficulty, irritability, diarrhea, and coma. Cardiac dysrhythmias such as heightened T wave and shortened QRS heart may lead to cardiac arrest. Calcium - Answers 8.6 -10.2 mg/dl Function: Plays a role in release of neurotransmitters, blood coagulation, maintains muscle tone and muscle contraction Essential in heart and brain functions. Foods rich in Ca+ : milk, cheese, broccoli and meat Hypocalemia - Answers Cause: Cause for Ca+ levels to drop include: inability to convert vitamin D, an increase of serum phosphorous, overuse of enemas and laxatives, sepsis burns, chronic malabsorption syndromes, and chronic renal failure. Hypoparathyroidism decrease in Ca+ level in blood causes an increase in PTH, this leads to the demineralization of the bone, and finally bone fractures. Also the citrate used In stored blood can bind Ca+ in multiple transfusions