UPDATED Fluid and Electrolyte Balance EXAM QUESTIONS AND CORRECT DETAILED ANSWERS

Nurses need to know: - ANSWER- which diseases and conditions may alter F&E balance, recognize s/sx of imbalance and interventions to help correct Water contents in average person (TBW) - ANSWER- Male: 60% Female: 50-55% Elderly: 45-55% Infants: 70-80% Primary Electrolytes - ANSWER- Na+ K+ Ca++ Mg P Cl- ICF - ANSWER- Intracellular Fluid ICF Info - ANSWER- about 40% of TBW maintains cell size & function ECF - ANSWER- Extracellular Fluid ECF Info - ANSWER- ~15-20% of TBW Intravascular Fluid - ANSWER- inside blood (plasma) 5% Interstitial Fluid - ANSWER- between cells, outside vascular space 15% Transcellular Space - ANSWER- small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids Body Fluid Regulation Image - ANSWER- Fluid & Electrolyte Shifting - ANSWER- Osmosis Diffusion Filtration Active Transport Osmosis - ANSWER- movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher Albumin - ANSWER- holds fluid in it's space; without it, water leaks out and causes edema with free moving fluid Diffusion - ANSWER- movement of solutes from higher concentration to lower Osmosis and Diffusion Image - ANSWER- Oncotic Pressure - ANSWER- Osmotic pressure exerted by proteins, especially albumin; large molecules hold fluid in vascular space Osmolality - ANSWER- osmotic force of solute per unit of wt of solvent; describes fluids inside the body Osmolarity - ANSWER- total milliosmoles of solute per unit of volume of solute; describes fluids outside the body Osmolality vs. Osmolarity - ANSWER- Often used interchangeably; Force of solute that forces solute one way or the other Isotonic - ANSWER- same concentration of particles as plasma Hypertonic - ANSWER- greater concentration of particles than plasma; bolus feeding/tube feeding Hypotonic - ANSWER- lesser concentration of particles than plasma; water based to keep cells plump -Tonic Image - ANSWER- Edema - ANSWER- fluid shifts from vascular space to interstitial space "Third Spacing" - ANSWER- major fluid shift from intravascular to interstitial space "Third Spacing" Problems - ANSWER- causes hypovolemia, hypotension, tachycardia, dec UOP Ascites - ANSWER- fluid in abdominal interstitial space Illnesses that cause F&E Imbalance - ANSWER- Cancer (N&V) Surgery (Blood Loss) Diabetes CHF Renal Failure Regulation of Fluid Input - ANSWER- Need: ml Fluids: 1500 Folids: 1000 Metabolism: 300 Total: 2800+ Fluid Output - ANSWER- Kidneys: mL Skin/Sweat: ~500 mL Lungs: ~400 mL GI: 100-200 mL Should I&O always be equal? - ANSWER- No, it depends on pt fluid status if they need to retain or remove fluid. Dehydration - ANSWER- the loss of pure water alone without loosing Na+ Fluid Volume Deficit - ANSWER- includes the loss of body fluids and electrolytes; fluid loss is often isotonic FVE - ANSWER- Fluid Volume Excess FVD - ANSWER- Fluid Volume Deficit FVE Causes - ANSWER- CHF, Cushings, Liver Disease, Renal Failure, Meds FVD Causes - ANSWER- Vomiting, Diarrhea, Fistulas, GI suctioning, 3rd Spacing, diuretics, hemorrhage, decreased intake Assessment for Fluid Balance - ANSWER- Hx, VS, I&O, Wt, Skin turgor/moisture, Mucous membranes, Lung sounds, JVD, Edema, LOC, Labs 1 L H2O - ANSWER- 2.2 lb or 1 kg High Risk Groups - ANSWER- Infants Elders Post-Op/NPO Vomiting/Diarrhea Diuretics Chronic Disease Elders at Risk - ANSWER- impaired thirst mechanism cause dehydration and inc Na+, inc risk of FVE Chronic Diseases at Risk - ANSWER- Renal