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Lecture 11

NURS 364 Lecture Notes - Lecture 11: Body Water, Lymph Node Biopsy, Oncotic Pressure


Department
Nursing
Course Code
NURS 364
Professor
Deborah Van Kuiken
Lecture
11

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DISORDERS OF FLUID & ELECTROLYTE
Pathophysiology NURS 364
BODY WATER AND FLUIDS
Body fluids are composed of water and various dissolved substances (solutes)
Total body water constitutes about 60% of the total body weight
The average fluid intake and output is about 2500ml over a 24-hour period.
Distribution of Total Body Water (TBW)
Water, nutrients, waste movement
Movement of water between capillaries and interstitial space
Water Movement Between Plasma (Vascular) & Interstitial Fluid
Water, nutrients & waste moves between capillaries and interstitial spaces as a result of
pressure changes at the arterial and venous end of capillaries.
Water, sodium & glucose readily move across capillary membrane.
However, Protein (Albumin) does not cross the capillary membrane and maintains the
capillary oncotic pressure
Water Movement Between Plasma (Vascular) & Interstitial Fluid
Two types of forces determine whether fluid will move in or out of the capillaries and interstitial
spaces
Hydrostatic pressurePUSHES fluid (garden hose with a hole in it. If only a little pressure
not much happens but a lot of pressure water shoots out)
Directly proportional to amount of fluid
Oncotic pressure PULL fluid
Maintained by protein (Albumin)- albumin should not leak out of capillaries in a
healthy state
Water Movement Between Plasma (Vascular) & Interstitial Fluid
Hydrostatic pressure
Capillary hydrostatic pressure – pushes fluid out of the capillaries into the interstitial
spaces
Interstitial hydrostatic pressure – pushes fluid from interstitial spaces into the capillaries
Oncotic pressure*
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Capillary oncotic pressure – osmotically pulls fluid from interstitial spaces into the
capillaries
Interstitial oncotic pressure – osmotically pulls fluid from capillaries out to the
interstitial spaces
*usually due to proteins; but can be other molecules like glucose
Water Movement Between Plasma (Vascular) & Interstitial Fluid
Sometimes it doesn’t quite work…
Alteration in Water Movement between Capillaries and Interstitial Spaces
Edema - the accumulation of fluid within the interstitial spaces.
Occurs with conditions or diseases that increases the forces favoring fluid movement out of the
capillaries:
Increased capillary hydrostatic (Filtration) pressure- obstruction on venous side
Lowered plasma oncotic pressure- decreased plasma albumin
Increased capillary membrane permeability (leaky)- inflammation
Lymphatic channel obstruction- cancer removed lymph nodes
EDEMA
Increased Capillary Hydrostatic Pressure
From localized fluid congestion or increased systemic fluid volume.
Local venous obstruction:
Venous Thrombosis
Tight clothing on extremities
Prolonged standing
Salt or water retention
Liver Cirrhosis
Congestive heart failure
Renal failure
EDEMA
Decreased plasma oncotic pressure:
Decreased plasma albumin
Liver disease /Protein malnutrition
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Plasma proteins loss:
Hemorrhage, burns
Glomerular diseases of kidney
Increased capillary permeability:
Inflammation- increased permeability
Lymphatic channels blocked or removed:
Tumors
Lymph node biopsy
What to watch for with Edema
Weight gain – especially with generalized edema
Swelling and puffiness
Limited movement in affected joints (pain too!)
Potential disturbance in blood flow
Decreased pulses
affects delivery of nutrients and removal of waste from tissues  cell and tissue injury
Skin breakdown
Edema of organs like brain, lung, larynx can be life threatening.
EDEMA: PITTING VS. NONPITTING
Pitting Edema
Accumulation of interstitial fluid exceeds reabsorption
Non-Pitting Edema
Plasma proteins have accumulated in the interstitial space, pulling water with them
Third Spacing
Accumulation and sequestration of trapped extracellular fluid in an actual or potential
body space
These fluids do not readily exchange with the ICF or ECF fluids
Called “effusions” or “hydro-”
Manifestations depends on organs affected
Movement of water between interstitial space and the cells
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