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NSG 211 - EXAM 2 REVIEW.
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NSG 211 - EXAM 2 REVIEWFUNCTIONS OF WATER IN BIOLOGY
CRITICAL IN MAINTAINING HOMEOSTASIS ,STATIC PRESSURE FOR BLOOD PRESSURE/
PERFUSION OFTEN SOLVENT OF METABOLIC REACTIONS
MEDIUM TO TRANSPORT NUTRIENTS INTO CELLS AND WASTES FROM CELLS :
DEHYDRATION= HYPOXIA
TRANSPORTS BLOOD COMPONENTS:
OXYGEN FACILITATES JOINT MOVEMENT
O CONSIDER BODY WATER COMPOSITION:
TOTAL BODY WATER (TBW): WE ARE MOSTLY
WATER 70% OF OUR BODY WATER IS IN CELLS
ADULTS: 60% TBW
WOMEN AND OBESE: 50% TBW (ESTROGEN PROMOTES ADIPOSE, WHICH IS HYDROPHOBIC)
ELDERLY: 50% TBW, (DECREASE IN PHYSIOLOGY)
INFANTS: 70% TBW, INEFFICIENT CONSERVATION OF WATER> IMMATURE MECHANISMS)
O RESULTS: INFANTS, ELDERLY, OBESE & WOMEN AT GREATER RISK OF DEHYDRATION DURING DISEASE.
COMPARTMENTS AND WATER MOVEMENT
O FLUID COMPARTMENTS:
INTRACELLULAR COMPARTMENT (ICF): EVERYTHING INSIDE (70% OF WATER HERE)
ALL NUTRIENTS EXCEPT WATER STRICTLY REGULATED ACTIVE TRANSPORT
EXTRACELLULAR COMPARTMENT (ECF)
INTRAVASCULAR FLUID (IVF): BLOOD (VASCULAR COMPARTMENT). LABS DRAWN HERE
INTERSTITIAL FLUID, (ISF): BATHE CELLS, SUPPLIES CELL “TRANSPORTATION” OF NEEDS
CEREBROSPINAL FLUID (CSF)
TRANSCELLULAR FLUIDS (PERICARDIAL OR JOINT)
WHEN CONSIDERING, FLOW OF WATER/ NUTRIENTS: 2 TRANSFERS TO CONSIDER :
CELLULAR MEMBRANE: BETWEEN ISF AND ICF (ACTIVE TRANSPORT), ATP USED
IVF (BLOOD) VS. ISF/CELLS: FREE FLOW OF NUTRIENTS/ WASTES (GRADIENT),
EX: OSMOSIS
FLUID BALANCE
O MOVEMENT OF WATER: “FREE” (NO ATP)
OSMOSIS: FLOW OF WATER FROM HIGH CONCENTRATION OF WATER TO LOW
CONCENTRATIONS OF WATER TO LOW CONCENTRATION OF WATER (IE: MOVES TOWARD
HIGH CONCENTRATION OF SALT, HIGHER “OSMOLARITY”)
O TWO MAJOR FORCES INVOLVED IN FLOW SHIFTS ARE: “TIDAL”
HYDROSTATIC PRESSURE (PISTON, HIGH TIDE): “PUSH” PRESSURE TO TAKE FLUID OUT
FROM EX: SODIUM-(NA+), BLOOD VOLUME (BP)
OSMOTIC PRESSURE (SPONGE, EBB TIDE): PULL OR “SUCKING” PRESSURE TO BRING FLUID
TOWARD EX: BLOOD PROTEINS (ALBUMIN); RBC’S; EVEN NA+ IN VEINS , PULL FLUID INTO
VASCULAR COMPARTMENT.
+PERMEABILITY: ABILITY FOR FLUID TO GET THROUGH MEMBRANE (HISTAMINE)
CONTROL OF FLUID BALANCE
THIRST MECHANISM IN THE HYPOTHALAMUS: OSMORECEPTORS TO HIGH
SALT CONCENTRATION
O ANTIDIURETIC HORMONE (ADH): STIMULATES KIDNEY REABSORPTION OF “PURE
WATER”
, LOW BP: KIDNEYS SECRETE RENIN> ANGIOTENSIN II> STIMULATES ADRENAL GLANDS TO
SECRETE:
O ALDOSTERONE> SIGNALS KIDNEYS> INCREASE REABSORPTION OF NA+ (AND
THUS H2O) (K+ OUT)
EDEMA
CAUSES OF PERIPHERAL EDEMA: CONSIDER MAJOR PLAYERS IN FLUID SHIFTS LISTED ABOVE
O EXCESSIVE AMOUNT OF FLUID IN THE INTERSTITIAL COMPARTMENT
CAUSES SWELLING OR ENLARGEMENT OF THE TISSUES
OFTEN LOCALIZED, BUT CAN BE GENERALIZED (“ANASARCA”)
O CAUSES OF EDEMA
INCREASED CAPILLARY HYDROSTATIC PRESSURE
(HYPERTENSION) INCREASES HYDROSTATIC PRESSURE
LOSS OF PLASMA PROTEINS (ALBUMIN)
LOW OSMOTIC PRESSURE (LIVER DISEASE)
INCREASED CAPILLARY PERMEABILITY (INFLAMMATION)
OBSTRUCTION OF THE LYMPHATIC SYSTEM
INCREASED HYDROSTATIC PRESSURE,
“BACKUP” RAPID HYPONATREMIA
O EFFECTS OF EDEMA
GENERALIZED EDEMA: UNIFORM DISTRIBUTION
DEPENDENT EDEMA: GRAVITY-DEPENDENT AREAS, EX: SACRAL/BUTTOCKS OR
FEET/LEGS PITTING VS. NON-PITTING
WEIGHT GAIN FROM WATER
RETENTION SWELLING
TIGHT CLOTHES
DECREASES JOINT MOVEMENT (FUNCTIONAL IMPAIRMENT (ESPECIALLY
JOINTS)) PAIN
IMPAIRED ARTERIAL CIRCULATION (DELAYED HEALING)
THIRD SPACING: NOT VASCULAR, NOT CELLULAR
CAUSES, GENERAL SIGNS/SYMPTOMS OF DEHYDRATION: WHAT CAUSES IT? WHAT DO YOU SEE?
O CAUSES:
INSUFFICIENCY FROM EITHER EXCESSIVE LOSS, INADEQUATE INTAKE, OR
BOTH. MORE SERIOUS IN ELDERLY, OBESE, AND INFANTS
DECREASED FLUID RESERVES AND ABILITY TO CONSERVE FLUID QUICKLY UNDER STRESS
VOMITING & DIARRHEA, EX: AMOEBIC DYSENTERY, VIRAL GASTROENTERITIS, EXCESSIVE
SWEATING, DIABETIC KETOACIDOSIS (INSENSIBLE LOSS, POLYURIA FROM GLUCOSURIA),
INSUFFICIENT WATER INTAKE, INSENSIBLE LOSS: RESPIRATION, METABOLISM (FEVER)
THIRD SPACING: NONFUNCTIONAL COLLECTION OF FLUID (EX: BURNS)
O MANIFESTATIONS
DRY MUCOUS MEMBRANES, DECREASED SKIN TURGOR, TACHYCARDIA (TACHYCARDIA IS
AN EARLY SIGN) AND THEN HYPOTENSION, WEAK AND THREADY PULSE, FATIGUE,
INCREASES HEMOCRIT COUNT (BLOOD BECOMES CONCENTRATED)
METABOLIC ACIDOSIS (LACK OF CIRCULATION> ISCHEMIA>ANAEROBIC
METABOLISM>LACTIC ACID)
POLYDIPSIA (HYPOTHALAMIC THIRST MECHANISM
OLIGURIA-(INCREASED ADH & RENIN/ALDOSTERONE SECRETION)
SYMPATHETIC STIMULATION- (CATECHOLAMINES: EPINEPHRINES AND NOEPINEPRHINES)
VASOCONSTRICTION: CONSTRICTING CUTANEOUS BLOOD VESSELS (PALE, COOL SKIN)
, USUALLY, HYPERNATREMIA: RESULTS IN WATER PULLED TO BLOOD, SO CELLS LOSE
WATER (CRENATION)
CELLS LOSE FUNCTION, DECREASING FUNCTION ( MENTAL CONFUSION, DECREASED LOC)
O ANAEROBIC METABOLISM FROM DEHYDRATION / HYPOXIA
O CAN BE HYPOXIC BUT NOT ANEMIC.
O OBESE HAVE HIGH ADIPOSITY WHICH IS MADE OF LIPIDS WHICH ARE HYDROPHOBIC
NORMAL VALUES OF SODIUM POTASSIUM. MAJOR FUNCTIONS AND MANIFESTATIONS OF ABNORMALITIES
WITHNA+, K+, CA+, P.
O SODIUM (NA+)- (135-145 MEQ/L)
MAINTAINS EXTRACELLULAR FLUID VOLUME (HYDROSTATIC PRESSURE)
NERVE CONDUCTION (NA-K PUMP CREATES NERVE CELLULAR ACTION POTENTIAL
MAJOR CATION (+) IN THE EXTRACELLULAR FLUID (HIGH IN INTRAVASCULAR AND LOW
IN INTRACELLULAR)
CONTROLS VASCULAR VOLUME
IMPORTANT IN NEUROLOGICAL FUNCTION (INVOLVES ACTION POTENTIAL-NA/K PUMP
ALLOWS FOR DIFFUSION OF FLUID BETWEEN VASCULAR AND INTERSTITIAL COMPARTMENTS
(OSMOSIS)
CONTROLLED BY RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
(RAAS) DRIVEN BY KIDNEY GLOMERULAR FILTRATION RATE (GFR)
RENIN> ANGIOTENSIN II> NA-K PUMP (ACTIVE TRANSPORT)(3 NA+ OUT, 2 K+ IN)
MAINTAINS HIGH EXTRACELLULAR LEVELS (90% OF SOLUTES)
NA+ SOURCES- FOOD AND BEVERAGES AND IV FLUIDS (DETERMINES TONICITY)
NA+ LOSS- PERSPIRATION, URINE , FECES
RECALL- NA+ FUNCTIONS: VOLUME CONTROL
NERVE CONDUCTION AND MUSCLE CONTRACTION
BOTH HIGH AND LOW NA+ CAUSE NEURO CHANGES
HYPONATREMIA (<135 MEQ)
CAUSES
O SWEATING/ VOMITING/ DIARRHEA
O MANY DIURETICS: MOST CAUSE NA+ & K+ LOSS
O IATROGENIC: GIVING HYPOTONIC IV FLUIDS
O HORMONAL IMBALANCES
LOW ALDOSTERONE ( ADDISON’S DZ: ADRENAL INSUFFICIENCY)
SIADH: PRIMARY DZ AND PARANEOPLASTIC SYNDROMES
MANIFESTATIONS
O IMPAIRED NERVE FUNCTIONS: CONFUSION
O FLUID IMBALANCE: HYPOTENSION, EDEMA
O DECREASED OSMOTIC PRESSURE IN IVC
HYPOVOLEMIA/HYPOTENSION
O BRAIN CELLS MAY SWELL (MORE NA IN CELLS)
CEREBRAL EDEMA
CONFUSION, COMA, SEIZURES, DEATH
O TREATMENTS
GIVE NA+
USUALLY HYPERTONIC IV FLUIDS
HYPERNATREMIA
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