1
NR 324: Adult Health I Exam 1 Study Guide
This study guide may not include all the material in the exam. Please Read the course textbook.
Any of the material covered in lecture, PowerPoints, and textbook are testable material.
Chapter 17:
Water Content of the Body
• 2/3 of water is intracellular fluid in the cells
• 1/3 of water is in extracellular fluid outside of cells
• More fat in the body the less water
• 1 L of water =2.2 lbs
• 3-6 L of fluid is secreted in and reabsorbed from GI everyday
• Fluid volume over load: asses for edema crackle, the blood pressure would increase, and the sat will
lower
• Body fluid Compartments
o Interstitial-the fluid in the spaces between cells
o Intravascular (plasma)- the liquid part of blood
o Transcellular-a very small amount of fluid contained within specialized cavities of the body.
Transcellular fluids include cerebrospinal fluid; fluid in the gastrointestinal (GI) tract; and pleural,
synovial, peritoneal, intraocular, and pericardial fluid.
o ECF consists of one third of the body water; this would amount to about 14 L in a 70-kg man.
About 20% of ECF is in the intravascular space as plasma (3 L in a 70-kg man), and 70% is in the
interstitial space (10 L in a 70-kg man). The fluid in the transcellular spaces totals about 1 L at any
given time. However, because 3 to 6 L of fluid is secreted into and reabsorbed from the GI tract
every day, loss of this fluid
• Calculation of fluid Gain or Loss
o One liter of water weighs 2.2 lb (1 kg). Body weight change, especially sudden change, is an
excellent indicator of overall fluid volume loss or gain. For example, if a patient drinks 240 mL
(8 oz) of fluid, weight gain will be 0.5 lb (0.23 kg).
Mechanisms Controlling fluid and Electrolytes
• Cations are positively charged ions. Examples include sodium (Na+), potassium (K+), calcium (Ca2+), and
magnesium (Mg2+) ions. Anions are negatively charged ions. Examples include bicarbonate (HCO 3−),
chloride (Cl−), and phosphate (PO43−) ions. Most proteins bear a negative
o Main cation that is in the cell potassium
o main cation that is outside the sodium
• Theimilliequivalent i(mEq)iis itheicommonlyiusediunitiofimeasureifor ielectrolytes.
• Diffusion-Diffusion is the movement of molecules from an area of high concentration to one of low
concentration.
o Diffusion is passive and requires no energy other than that of the concentration gradient.
• Facilitated Diffusion-Uses carrier to move molecules
o Facilitated diffusion involves the use of a protein carrier in the cell membrane to move molecules
that cannot otherwise pass through the membrane. Glucose transport into the cell is an example
of facilitated diffusion. A carrier molecule on most cells increases or facilitates the rate of
diffusion of glucose into these cells.
o Facilitated diffuse is a protein carrier, we use no energy
• Active Transport-Active itransport iis ia iprocess iiniwhichimolecules imove iagainst ithe iconcentration
gradient. External energy is required for this process. An example is the sodium-potassium pump. The
concentrations of sodium and potassium differ greatly intracellularly and extracellularly (see Fig. 17-3). To
maintain this concentration difference, the cell uses active transport to move sodium out of the cell and
potassium into the cell (Fig. 17-5). The energy source for this mechanism is adenosine triphosphate (ATP),
produced in the cell's mitochondria.
o Active transport uses external energy to move molecules against the concentration gradient—
from an area of low concentration to an area of high concentration.
Page 1 of 21
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o An example of active transport is the sodium-potassium pump. ATP is used to move sodium out
of the cell and potassium into the cell.
• Osmosis- Osmosis is the movement of water through a semipermeable membrane that does not allow
solutes to cross.
o Water moves from the less concentrated side (has more water) to the more concentrated side
(has less water).
o Requires no energy.
o Water movement stops when the concentration differences disappear orhydrostatic pressure
builds sufficiently to oppose any further movement of water.
o Osmolarity measures the total milliosmoles per liter of solution, or the concentration of
molecules per volume of solution (mOsm/L).
o Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of
molecules per weight of water. Osmolality is the test typically performed to evaluate the
concentration of plasma and urine.
▪ Normal plasma osmolality is between 275 and 295 mOsm/kg. A value greater than
295 mOsm/kg indicates that the concentration of particles is too great or that the water
content is too little. This condition is termed water deficit. A value less than
275 mOsm/kg indicates too little solute for the amount of water or too much water for
the amount of solute. This condition is termed water excess.
▪ Osmolality iof iurineicanirangeifromi100 itoi1300 imOsm/kg, idependingionifluidiintake iand
it he iamount iof iantidiuretic ihormone i(ADH) iin icirculation iand ithe irenal iresponse ito iit.
▪ Hypotonic solution (H2O excess) results in cellular swelling.
• Hypotonic IV fluids
o 0.33,0.45
o More water than electrolytes
o Pure water lyses RBCs.
o Water moves from ECF to ICF by osmosis
o Usually maintenance fluids 0.45% NaCl
o Monitor for changes in mentation
▪ Isotonic solution (normal H2O balance) results in no change.
• Isotonic IV fluids
o Expands only ECF
o No net loss or gain from ICF
o Ideal to replace ECF volume deficit
o Isotonic does not affect the size of the cell
o Normal saline can only be given 0.9
▪ Hypertonic solution (H2O deficit) results in cellular shrinking.
• Hypertonic IV fluids
o Hypertonic
o Initially expands and raises the osmolality of ECF
o Require frequent monitoring of
▪ Blood pressure
▪ Lung sounds
▪ Serum sodium levels
o D.59,d 10
o Detrose makes it hypertonic
• Hydrostatic Pressure- is the force within a fluid compartment. In the blood vessels, hydrostatic pressure is
the blood pressure generated by the contraction of the heart. Hydrostatic pressure in the vascular system
gradually decreases as the blood moves through the arteries until it is about 30 mm Hg in the capillary
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bed. At the capillary level, hydrostatic pressure is the major force that pushes water out of the vascularsystem
and into the interstitial space.
o Hydrostatic is heart beat
o Hydrostatic pressure pushes
o The capillary bed that has a higher hydrostatic pressure is the arterial side
• Oncotic pressure is the osmotic pressure caused by plasma colloids in solution. Hence, it is also called
colloidal osmotic pressure. The plasma protein molecules attract water, pulling fluid from the tissue space
to the vascular space.
o Albumin is made in the liver. So if our blood pressure goes down, the liver will pull out more
albumin.
o Oncotic pressure is albumin…albumin pulls
o Oncotic pressure pulls
o Venous system pulls out for oncotic pressure
Fluid Spacing
• First spacing describes the normal distribution of fluid in ICF and ECF compartments.
• Second spacing refers to an abnormal accumulation of interstitial fluid (i.e., edema)
• Third-spaced fluid is trapped and unavailable for functional use. Examples of third spacing are with burns,
trauma, or sepsis. Doctor needs to remove this with procedure
o Third spacing is a big deal beacuase it wont go away on its own, you have to have a doctor take
care of it. An example is plueral effusion, ascites
Sodium Imbalances
• Sodium is the primary determinant of ECF osmolality
o Imbalances typically associated with parallel changes in osmolality
o The body regulates sodium through urine, sweat, and feces. The kidneys are the primary
regulator of sodium balance
o Plays a major role in
▪ ECF volume and concentration
▪ Generation and transmission of nerve impulses
▪ Muscle contractility
▪ Acid-base balance
o Our brain needs sodium. Loc changes with sodium imbalances
o Waterfollows sodium
• Hypernatremia (high sodium)w Nursing considerations..
o Manifestations
▪ Thirst, lethargy, agitation, seizures, and coma
▪ Impaired LOC
▪ Symptoms of fluid volume deficit
o Hypernatremia is not a problem in an alert person who has access to water, can sense thirst, and
is able to swallow. Hypernatremia secondary to water deficiency is often the result of an impaired
level of consciousness or an inability to obtain fluids.
o A deficiency in the synthesis or release of ADH from the posterior pituitary gland (central
diabetes insipidus) or a decrease in kidney responsiveness to ADH (nephrogenic diabetes
insipidus) can result in profound diuresis, producing a water deficit and hypernatremia.
o Hyperosmolality with osmotic diuresis can result from administration of concentrated
hyperosmolar tube feedings and hyperglycemia associated with uncontrolled diabetes mellitus.
Excessive sweating and increased sensible losses from high fever can also cause hypernatremia.
o Excessive sodium intake with inadequate water intake can also lead to hypernatremia. Examples
of sodium gain include IV administration of hypertonic saline or sodium bicarbonate, use of
sodium-containing drugs, excessive oral intake of sodium (ingestion of seawater), and primary
aldosteronism.
Page 3 of 21
NR 324: Adult Health I Exam 1 Study Guide
This study guide may not include all the material in the exam. Please Read the course textbook.
Any of the material covered in lecture, PowerPoints, and textbook are testable material.
Chapter 17:
Water Content of the Body
• 2/3 of water is intracellular fluid in the cells
• 1/3 of water is in extracellular fluid outside of cells
• More fat in the body the less water
• 1 L of water =2.2 lbs
• 3-6 L of fluid is secreted in and reabsorbed from GI everyday
• Fluid volume over load: asses for edema crackle, the blood pressure would increase, and the sat will
lower
• Body fluid Compartments
o Interstitial-the fluid in the spaces between cells
o Intravascular (plasma)- the liquid part of blood
o Transcellular-a very small amount of fluid contained within specialized cavities of the body.
Transcellular fluids include cerebrospinal fluid; fluid in the gastrointestinal (GI) tract; and pleural,
synovial, peritoneal, intraocular, and pericardial fluid.
o ECF consists of one third of the body water; this would amount to about 14 L in a 70-kg man.
About 20% of ECF is in the intravascular space as plasma (3 L in a 70-kg man), and 70% is in the
interstitial space (10 L in a 70-kg man). The fluid in the transcellular spaces totals about 1 L at any
given time. However, because 3 to 6 L of fluid is secreted into and reabsorbed from the GI tract
every day, loss of this fluid
• Calculation of fluid Gain or Loss
o One liter of water weighs 2.2 lb (1 kg). Body weight change, especially sudden change, is an
excellent indicator of overall fluid volume loss or gain. For example, if a patient drinks 240 mL
(8 oz) of fluid, weight gain will be 0.5 lb (0.23 kg).
Mechanisms Controlling fluid and Electrolytes
• Cations are positively charged ions. Examples include sodium (Na+), potassium (K+), calcium (Ca2+), and
magnesium (Mg2+) ions. Anions are negatively charged ions. Examples include bicarbonate (HCO 3−),
chloride (Cl−), and phosphate (PO43−) ions. Most proteins bear a negative
o Main cation that is in the cell potassium
o main cation that is outside the sodium
• Theimilliequivalent i(mEq)iis itheicommonlyiusediunitiofimeasureifor ielectrolytes.
• Diffusion-Diffusion is the movement of molecules from an area of high concentration to one of low
concentration.
o Diffusion is passive and requires no energy other than that of the concentration gradient.
• Facilitated Diffusion-Uses carrier to move molecules
o Facilitated diffusion involves the use of a protein carrier in the cell membrane to move molecules
that cannot otherwise pass through the membrane. Glucose transport into the cell is an example
of facilitated diffusion. A carrier molecule on most cells increases or facilitates the rate of
diffusion of glucose into these cells.
o Facilitated diffuse is a protein carrier, we use no energy
• Active Transport-Active itransport iis ia iprocess iiniwhichimolecules imove iagainst ithe iconcentration
gradient. External energy is required for this process. An example is the sodium-potassium pump. The
concentrations of sodium and potassium differ greatly intracellularly and extracellularly (see Fig. 17-3). To
maintain this concentration difference, the cell uses active transport to move sodium out of the cell and
potassium into the cell (Fig. 17-5). The energy source for this mechanism is adenosine triphosphate (ATP),
produced in the cell's mitochondria.
o Active transport uses external energy to move molecules against the concentration gradient—
from an area of low concentration to an area of high concentration.
Page 1 of 21
,2
o An example of active transport is the sodium-potassium pump. ATP is used to move sodium out
of the cell and potassium into the cell.
• Osmosis- Osmosis is the movement of water through a semipermeable membrane that does not allow
solutes to cross.
o Water moves from the less concentrated side (has more water) to the more concentrated side
(has less water).
o Requires no energy.
o Water movement stops when the concentration differences disappear orhydrostatic pressure
builds sufficiently to oppose any further movement of water.
o Osmolarity measures the total milliosmoles per liter of solution, or the concentration of
molecules per volume of solution (mOsm/L).
o Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of
molecules per weight of water. Osmolality is the test typically performed to evaluate the
concentration of plasma and urine.
▪ Normal plasma osmolality is between 275 and 295 mOsm/kg. A value greater than
295 mOsm/kg indicates that the concentration of particles is too great or that the water
content is too little. This condition is termed water deficit. A value less than
275 mOsm/kg indicates too little solute for the amount of water or too much water for
the amount of solute. This condition is termed water excess.
▪ Osmolality iof iurineicanirangeifromi100 itoi1300 imOsm/kg, idependingionifluidiintake iand
it he iamount iof iantidiuretic ihormone i(ADH) iin icirculation iand ithe irenal iresponse ito iit.
▪ Hypotonic solution (H2O excess) results in cellular swelling.
• Hypotonic IV fluids
o 0.33,0.45
o More water than electrolytes
o Pure water lyses RBCs.
o Water moves from ECF to ICF by osmosis
o Usually maintenance fluids 0.45% NaCl
o Monitor for changes in mentation
▪ Isotonic solution (normal H2O balance) results in no change.
• Isotonic IV fluids
o Expands only ECF
o No net loss or gain from ICF
o Ideal to replace ECF volume deficit
o Isotonic does not affect the size of the cell
o Normal saline can only be given 0.9
▪ Hypertonic solution (H2O deficit) results in cellular shrinking.
• Hypertonic IV fluids
o Hypertonic
o Initially expands and raises the osmolality of ECF
o Require frequent monitoring of
▪ Blood pressure
▪ Lung sounds
▪ Serum sodium levels
o D.59,d 10
o Detrose makes it hypertonic
• Hydrostatic Pressure- is the force within a fluid compartment. In the blood vessels, hydrostatic pressure is
the blood pressure generated by the contraction of the heart. Hydrostatic pressure in the vascular system
gradually decreases as the blood moves through the arteries until it is about 30 mm Hg in the capillary
Page 2 of 21
, 3
bed. At the capillary level, hydrostatic pressure is the major force that pushes water out of the vascularsystem
and into the interstitial space.
o Hydrostatic is heart beat
o Hydrostatic pressure pushes
o The capillary bed that has a higher hydrostatic pressure is the arterial side
• Oncotic pressure is the osmotic pressure caused by plasma colloids in solution. Hence, it is also called
colloidal osmotic pressure. The plasma protein molecules attract water, pulling fluid from the tissue space
to the vascular space.
o Albumin is made in the liver. So if our blood pressure goes down, the liver will pull out more
albumin.
o Oncotic pressure is albumin…albumin pulls
o Oncotic pressure pulls
o Venous system pulls out for oncotic pressure
Fluid Spacing
• First spacing describes the normal distribution of fluid in ICF and ECF compartments.
• Second spacing refers to an abnormal accumulation of interstitial fluid (i.e., edema)
• Third-spaced fluid is trapped and unavailable for functional use. Examples of third spacing are with burns,
trauma, or sepsis. Doctor needs to remove this with procedure
o Third spacing is a big deal beacuase it wont go away on its own, you have to have a doctor take
care of it. An example is plueral effusion, ascites
Sodium Imbalances
• Sodium is the primary determinant of ECF osmolality
o Imbalances typically associated with parallel changes in osmolality
o The body regulates sodium through urine, sweat, and feces. The kidneys are the primary
regulator of sodium balance
o Plays a major role in
▪ ECF volume and concentration
▪ Generation and transmission of nerve impulses
▪ Muscle contractility
▪ Acid-base balance
o Our brain needs sodium. Loc changes with sodium imbalances
o Waterfollows sodium
• Hypernatremia (high sodium)w Nursing considerations..
o Manifestations
▪ Thirst, lethargy, agitation, seizures, and coma
▪ Impaired LOC
▪ Symptoms of fluid volume deficit
o Hypernatremia is not a problem in an alert person who has access to water, can sense thirst, and
is able to swallow. Hypernatremia secondary to water deficiency is often the result of an impaired
level of consciousness or an inability to obtain fluids.
o A deficiency in the synthesis or release of ADH from the posterior pituitary gland (central
diabetes insipidus) or a decrease in kidney responsiveness to ADH (nephrogenic diabetes
insipidus) can result in profound diuresis, producing a water deficit and hypernatremia.
o Hyperosmolality with osmotic diuresis can result from administration of concentrated
hyperosmolar tube feedings and hyperglycemia associated with uncontrolled diabetes mellitus.
Excessive sweating and increased sensible losses from high fever can also cause hypernatremia.
o Excessive sodium intake with inadequate water intake can also lead to hypernatremia. Examples
of sodium gain include IV administration of hypertonic saline or sodium bicarbonate, use of
sodium-containing drugs, excessive oral intake of sodium (ingestion of seawater), and primary
aldosteronism.
Page 3 of 21
