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Concept Map Fluid Shifting
Intro to Nursing (N3290)
The University of Texas Medical Branch
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Concept map 1: Steps in determining which way fluid shifts
1. For our studies about fluid shifts, Na
+
(& NaCl) & proteins will be the solutes involved. They are the main solutes that drive
fluid shifts, which are based on osmosis -- movement of water from area of lower solute concentration to area of higher solute
concentration. (For questions involving K
and Ca
++
, think electrical status.)
2. Step by step process in understanding how a certain disease/disorder/situation/scenario cause fluid shifts: Remember that (for
our purposes) changes in fluid status begin in the plasma space. So in any scenario you are given:
STEP 1 is to think: “How has this scenario changed the concentration in the plasma space (ie, blood concentration)?”
o Has water been added to the blood or protein taken away (making the plasma space less concentrated)?
o Or has water been taken away from the blood (making the plasma space more concentrated)?
Also remember that the tissue fluid concentration status (cells and interstitial space) remains normal initially —the “normal”
number of solutes & “normal” amount of water exist in the tissue at the beginning of the scenario. When the plasma
concentration changed, it became either more concentrated or less concentrated than the normal tissue concentration.
STEP 2 is to think: “The plasma concentration has changed to be either more or less concentrated than the tissue. I now have
to figure out what happens next, based on the principle of osmosis (CONCENTRATION CALLS!)—which way will fluid go? Tissue
to blood (blood more concentrated—“calls” fluid into it)? Or blood to tissue (blood less concentrated, so tissue “calls” fluid)?”
STEP I: The scenario resulted in water taken away from plasma space. The blood is now _____ concentrated than it was & therefore _____ concentrated than the tissue fluid.
Tissue has normal concentration.
Normal tonicity of tissue fluid (interstitial fluid + ICF) is same or near-same as blood. Fluid flow between compartments is based on small, balanced changes throughout the day.
EX: Normal tonicity in plasma space (blood) is 0% NaCl
The changed, pathologic situation will Homeostasis: normal, “every-day” always be one of these two scenarios: status is that fluid compartments throughout body have essentially the same concentration most of the time. Pathologic scenario A:
STEP 2: which way
will fluid go: T to B
or B to T? _______
Pathologic scenario B :
STEP I: The scenario resulted in water added to
OR protein taken from plasma space. The blood
is now ____ concentrated than it was & therefore _____concentrated than the tissue fluid.
Tissue has normal
concentration. STEP 2: which way
will fluid go: T to B
or B to T? _______
B B
B
T T T
2
Concept map 2: PATHOLOGIC FLUID STATUS CHANGES
Fluid volume deficit Fluid volume overload
What begins the fluid status change? (increase vs
decrease in concentration of blood)
Something _____________________________the
concentration of the plasma space
Something _________________________the
concentration of the plasma space After the change in concentration, would the
serum osmolality be high or low?
Osmo will be___________ ; give it a number (see range): ____
Osmo will be___________ ; give it a number (see range): ____ After the change in concentration, would the
plasma space osmotic pressure be high or low?
Likely tonicity of blood after change? (hypertonic
vs hypotonic)
Likely oncotic pressure of plasma space after
change? (high vs low)
How does the plasma’s concentration change (and any of the other changes above) affect the relationship between blood and tissue?
Blood becomes ___________(more or less?)
concentrated than tissue fluid
Blood becomes _______ (more or less?)
concentrated than tissue fluid
Which way will fluid shift—T to B, or B to T?
Basic hydration “picture”? (dehydration vs fluid
overload)
What S&S are seen as part of this picture?
Basic hydration “picture”_____________________**.** S&S:
Basic hydration “picture”_____________________**.** S&S:
What disease processes could cause this fluid status change & S&S? (BE SURE YOU UNDERSTAND HOW THE DISEASE PROCESS CAUSED THE FLUID SHIFT AND S&S!)
Which of the body’s compensatory mechanisms could help return to normal fluid balance?
Normal serum osmo: 280-295.
(SEE IF YOU CAN FILL IN THE BLANKS ON YOUR OWN.. IN CTQ ANSWER SECTION)
Concept Map Fluid Shifting
Course: Intro to Nursing (N3290)
University: The University of Texas Medical Branch
