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Patho Fluid and Electrolyte Imbalance.docx

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Department
Nursing
Course
NURSING 2LA2
Professor
Peter Helli
Semester
Winter

Description
ReviewRenalphysiologyThebasicsoffluidbalanceThebasicsofelectrolytesinbodyfluidsFluidBalanceFluidbalanceatthelevelofthecapillaryreliesonabalancebetweenopposingforcesthepushingforceofhydrostaticpressureandthepullingforceofoncoticpressureAtthearterialendofthecapillaryhydrostaticpressureishigherthanoncoticpressureinthecapillarysofluidmovesorispushedoutintotheinterstitialspaceCurrentresearchshowsthatinterstitialhydrostaticpressurehasasmallnegativevalueandcontributesslightlytothemovementoffluidfromthecapillarytothetissueTowardthevenousendofthecapillarymuchofthefluidhasmovedtotheinterstitialspaceleavingthesolutesinparticulartheplasmaproteinsbehindThiscreateshighercapillaryosmoticpressurewhicheffectivelypullsfluidfromtheinterstitialspacebackintothevesselSomeparticlessuchasglucoseandelectrolytesmovefromthevesselintotheinterstitialspaceandcreateinterstitialcolloidalosmoticpressurepullingasmallamountoffluidintotheinterstitialspaceExcessinterstitialfluidistakenupbythelymphaticsandreturnedtothecentralcirculationFluidImbalanceFluidimbalancesatthecapillarylevelcanbeduetoseveralalterationsinnormalfluidmovementFirstincreasedcapillaryhydrostaticpressurecancausehigheramountsoffluidtoleavethecapillaryIfhydrostaticpressurecontinuestobehighatthevenousendofthecapillarynetfluidmovementwillbeoutofthecapillaryIncreasedcapillaryhydrostaticpressurecanresultfromhypertensionorfromanincreaseinfluidvolumeHydrostaticpressurealsoincreasesifthereisanybackupofbloodflowForexampleaDVTmightobstructvenousbloodflowresultinginhigherthannormalpressureatthevenousendofthecapillaryThesecondthingthatcangowrongwithfluidbalanceisalackofsufficientcapillaryoncoticpressuretopullfluidbackintotheintravascularspaceintothecapillaryatthevenousendofthecapillaryBecausealbuministhemostprevalentcolloidorsolidintheplasmaanyclinicalsituationthatresultsindecreasedalbumincanresultinadecreaseofcapillaryoncoticpressureCommonmedicaldiagnosesassociatedwithlowalbuminareburnsliverdiseasemalnutritionandexcessivewounddrainageThethirdmechanismthatcausesfluidimbalanceatthecapillarylevelisincreasedinterstitialcolloidalosmoticpressureWhensolutesescapefromthevesselintotheinterstitialfluidtheywilltakefluidwiththemandholdthatfluidintheinterstitialspaceThecapillarymembraneshouldallowonlysomesolutestoescapeCapillarypermeabilityincreasesinresponsetothechemicalmediatorsoftheinflammatoryprocessFinallythefourthmechanismthatresultsinfluidimbalanceatthelevelofthecapillaryisanincreaseintissuehydrostaticpressureThiscanhappenwhenthelymphaticsareobstructedforsomereasonanddonotremoveexcessfluidandiscomplicatedbyincreasedtissueoncoticpressurewhichcontinuestopullfluidfromvesselLymphaticobstructioncanoccurinliverdiseaseorbecauseofphysicalobstructionfromsurgeryEdemarepresentsanincreaseinfluidintheinterstitialspaceHereisanotherwayoflookingatthemechanismsthatcauseedemaIncreasedcapillaryhydrostaticpressurecausesfluidtomoveintothetissuecreatingedemaAdecreaseinplasmaproteinsresultindecreasedcapillaryoncoticpressureThelackofpullfactorsmeansthatfluidremainsintheinterstitialspaceinsteadofmovingbacktothevesselThisisedemaEdemaLeakycapillariesorincreasedcapillarypermeabilityresultsinthelossofintravascularproteinsandothersolidstotheinterstitialspaceThismovementisaccompaniedbyfluidandthesoluteskeepthefluidandthesoluteskeepthefluidintheinterstitialspaceThatsedemaLymphaticobstructionresultsindecreasedabsorptionofinterstitialfluidandthereforeedemaEdemaorThirdSpacingEdemaistheaccumulationoffluidintheinterstitialspaceSometimesfluidbecomestrappedinthetranscellularcompartment
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