Osmolality Is The Term Used To Refer To The Osmotic Pressure Of A Solution - Engineering Assignment Help

Assignment Task

2.1 Critically analyse and outline your understanding of effective osmolality. 
Osmolality is the term used to refer to the osmotic pressure of a solution, which is expressed as osmols per kilogram (Osm/kg) or milliosmols per kilogram (mOsm/kg). Osmotic pressure is the minimum hydrostatic pressure applied to a solution to oppose the movement of solvent across a semipermeable membrane in response to a differing osmotic gradient. Effective osmolality is the tonicity of a solution and is equal to the sum of concentrations of solutes that have the capacity to exert an osmotic force across a membrane. This is the movement of solvent to through a semi-permeable membrane from a region of high solvent/low solute concentration to a region of low solvent/high solute concentration in order to equalise the concentration of the solution on both sides of the semi permeable membrane. 
3.1 Critically analyse the physiological responses/changes that occur in the body to maintain osmoregulation and the regulation of vascular volume. 
The homeostasis of fluids within the body is regulated by the body's osmoreceptors which work to monitor the solute concentration of plasma and initiate positive and negative feedback loops to influence fluid intake and output to maintain fluid balance. Fluid intake is regulated through the thirst-control centre within the hypothalamus of the brain, which directly the conscious desire to consume water. This mechanism is stimulated in the instance of dry pharyngeal mucosa membranes, increased plasma osmolarity, hypovolaemia, depleted potassium, renin-angiotensin-aldosterone system (RAAS) activation and psychological factors. Antidiuretic hormone also plays a role in the osmoregulation and regulation of vascular volume within the body. Antidiuretic hormone increases the permeability of renal tubules and collecting ducts, this allows for the return of fluid to the intravascular space in order to dilute the blood and decrease its osmolality. Once normal osmolality has been re-established, the osmoreceptors halt the stimulation of antidiuretic hormone and urinary output is restored.  Additionally, the RAAS system also influences vascular volume and fluid output. Renin is a proteolytic enzyme secreted by the kidneys in response to a decrease in renal perfusion secondary to a depletion of extracellular volume. The liver synthesises and secretes angiotensinogen, which is then cleaved by renin in order to create angiotensin I. Angiotensin I is then cleaved to form angiotensin II by the angiotensin converting enzyme (ACE). This causes blood vessel vasoconstriction which increases blood flow to the kidney, thus, increasing renal perfusion. Additionally, the presence of angiotensin II stimulates the secretion of aldosterone from the renal cortex. Aldosterone acts on the distal portion of the renal tubule to increase the reabsorption of Na+ and the excretion of Ka+ and H+. This increases vascular volume, as fluid is subsequently retained as a result of Na+ reabsorption. The regulation of vascular volume is critical for an individual's health as it ensures they remain euvolemic and prevents them from becoming hypovolemic or hypervolemic.  
3.2 Discuss the causes and effects of fluid volume excess and fluid volume deficit. 
Fluid volume excess is the term used to describe fluid retention within the body. This is caused by a surplus of total body Na+, thus, resulting in a consequent compensatory increase in extracellular fluid. Fluid volume excess is often seen in patients with heart failure, kidney failure or liver failure as these diseases often compromise Na+ regulatory mechanisms.  
Fluid volume deficit is the term used to describe decreased intravascular, interstitial, and/or intracellular fluid. This is caused when fluid output exceeds fluid intake, preventing the body from carrying out normal functions and causing dehydration. Fluid volume deficit is often seen in patients with diarrhoea, vomiting and nausea. 

3.3 Discuss the term ‘third spacing’ and provide an example of when third spacing occurs. 
Third spacing is the movement of fluid from the intravascular compartment to the interstitial space. This may be seen in patients with heart failure due to increased capillary hydrostatic pressure.   
4.1 Refer back to your data from Activity One (Part A and B) and critically analyse how and why electrolyte imbalances can affect a patient’s physiology, behaviour, mood and mental state. 
Chronic disease such as renal failure can cause an imbalance in a patient's fluid and electrolyte status, leading to complications such as fluid overload and hypernatremia such as the case with Mr. Clooney. Untreated fluid and electrolyte imbalances can have a negative effect on a patient's physiology, behaviour, mood and mental status. For example, hypernatremia causes cells to become dehydrated and shrink causing alteration of membrane potentials as fluid is removed from the intracellular space to the intravascular space as an attempt to maintain homeostasis. The effects of cellular dehydration are seen primarily in the central nervous system as the alteration of membrane potentials from electrolyte flux and shrinkage of neurons leads to ineffective functioning. This can result in the development of dizziness, headaches, haemorrhage, tachycardia, hypotension, convulsions, seizures and coma. Renal impairment can lead to accumulation of waste by products causing complications such as uraemia, which is a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys. This will also have a negative impact on Mr Clooney as ongoing uraemia can cause trouble concentrating, extreme tiredness or fatigue, little or no appetite, headaches, nausea, seizures, cardiac arrest and coma. 
 5.1 Locate a completed fluid balance chart and fluid balance summary in your clinical area. 
The fluid balance chart of an inpatient waiting in the patient care area for a scan was completed to a good standard as the information was documented clearly and it was thoroughly filled out every hour. The fluid balance chart included oral input as well as intravenous inputs, including flushes and medications rather than just normal saline intravenous input. The output was also documented well and included amounts from output devices such as an indwelling urinary catheter and ascitic drain, as well as an amount from a recent vomiting episode. 
 5.2 Identify at least two nursing strategies to facilitate accurate fluid balance documentation. 
Nursing strategies to facilitate accurate fluid balance documentation include: 
• Explaining to the patient that we are recording their fluid input and output and educating the patient on why this is important for their care. Therefore, the patient will feel involved within their care and will be more likely to communicate their fluid consumption and measure their urine output.   
• Mentioning during hand over that the patient is on a fluid balance chart to ensure continuity of care between clinicians (e.g. including this information during handover from ward nurse to DMI nurse). 

5.3 Outline the importance of maintaining consistent and accurate fluid balance charts to ensure positive patient outcomes.  
Maintaining a consistent and accurate fluid balance chart allows clinicians to identify trends in a patient's fluid intake and output, thus, ensuring the identification of fluid deficits or fluid overload. This is important for facilitating positive patient outcomes as a positive or negative fluid balance can be indicative of acute illnesssuch as acute kidney injury, electrolyte disturbances and plasma protein insufficiency. 

Explain why a daily weight is an accurate form of volume status and how to ensure that a daily weight is accurate. 
Weighing patients daily is an accurate and non-invasive form of measuring fluid volume status as assumes a one kilogram change in body weight equates to a one litre gain or loss in body fluid volume. Daily weighs should be performed at the same time each day, whilst the patient is wearing the same clothes and using the same scale.  
6.1 Describe the investigations and targeted assessments that should be completed to determine a patient’s fluid/electrolyte status. Provide a rationale for the investigations and targeted assessments. 
(Albumin, Alkaline phosphatase, Alanine transaminase, Aspartate aminotransferase, Blood urea nitrogen, Serum calcium, Serum chloride, Carbon dioxide (CO2), Creatinine, Bilirubin (total and direct), Gamma-glutamyltranspeptidase, Glucose, Lactate dehydrogenase (LDH), Serum phosphorus, Serum potassium, Total cholesterol, Total protein, Uric acid) 
This test is used to determine the concentrations or levels of key electrolytes, enzymes, sugars, proteins and metabolites and by-products within the blood. This provides the treating clinician with an overview of the patient's general health and may indicate the need for additional testing.   
BUN (blood urea nitrogen) 
This test measures urea and nitrogen level in the blood. Urea is a by-product of protein metabolization in the liver, this process produces ammonia which is then converted into the lesser toxic waste product urea. This test is often ordered in conjunction with a creatinine test to assist in diagnosing renal disease and/or to monitor renal dysfunction and failure. This is because an increased level of BUN is indicative of insufficient and/or impaired renal filtration as these waste products are normally filtered from the blood and released in urine.  
Creatinine and eGFR (estimated glomerular filtration rate) 
This test measures the level of creatinine in the blood. Creatinine is a by-product produced by muscles from the breakdown of creatine. Testing creatinine is another good indicator of renal functioning, as all creatinine produced is filtered from the blood by the kidneys and excreted in urine. Additionally, glomerular filtration rate (GFR) is also used in conjunction to measure of the function of the kidneys. The glomerulus is tuft of capillaries located within in the Bowmans Capsule of the that filter waste products from the blood, whilst preventing the loss of important constituents. The kidneys are responsible for filtering roughly 200L of blood, to produce roughly 2L of urine per day. The EGFR refers to the amount blood that is filtered by the glomeruli per minute, therefore, as a person's kidney function decreases, the filtration rate declines, and waste products accumulate in blood. 
Serum Osmolality and Osmolar Gap 
This test measures the amount of dissolved substances such as sodium, potassium, chloride and glucose in blood. This test is often used to determine any fluid and electrolyte imbalances, particularly an imbalance of the electrolyte Na+ as this is the major electrolyte present in blood and urine and is critical in maintaining the body's electrical neutrality and acid base balance.  
Urinalysis 
(pH, Specific gravity, Protein, Glucose, Ketones, Bilirubin, Red blood cells, White blood cells, Bacteria, Yeast, Casts and Crystals)  
A urinalysis is a group of physical, chemical, and microscopic tests that is used to detect abnormalities in urine samples. This provides the treating clinician with an overview of the status of a patient's renal system and may indicate underlying pathologies.   
Specific Gravity 
Urine specific gravity is a measure of urine concentration. Specific gravity is the measurement of particles dissolved in urine in comparison with the density of water.  
7.1 Evaluate the assessment results of your patient to determine their level of malnutrition. Discuss the following 
• Identify patients who are at risk of refeeding syndrome. 
Patients at risk of re-feeding syndrome include patients with eating disorders (anorexia nervosa) or disordering eating patterns (fasting, calorie restriction, purging), patients with a background of famine or poverty, patients with trouble consuming food or a disease process preventing adequate food consumption (dysphagia, recent surgery, cancer, etc.) and patients with alcoholism and diabetes mellitus. 
• Discuss the risk of rapidly reintroducing nutrition to a starving or malnourished patient. 
Rapidly reintroducing nutrition to a patient who is starved or malnourished can result in hormonal and metabolic changes causing potentially fatal electrolyte and fluid shifts within the body. 
• Critically discuss how the electrolyte shift occurs and how this can be managed. 
During refeeding, the presence of glucose within the blood stream triggers the decreased secretion of glucagon and increased secretion of insulin, therefore, also stimulating glycogen, adipose and protein synthesis. The release of insulin allows for the transport of glucose into the cells, along with potassium through the sodium-potassium ATPase symporter. Magnesium, phosphate and water/fluid are also up taken into the cells. This decreases the serum levels of potassium, magnesium and phosphate, all of which are already severely depleted, resulting in the clinical features and functional deficits of hypokalaemia, hypomagnesaemia and hypophosphatemia.
To prevent/manage complications when reintroducing nutrition to patients who are starving clinicians should: 
•  Start re-feeding slowly and increase feeding over 4-7 days as clinically indicated, amount of nutrition should be calculated by treating doctor in accordance with patient's body weight and status 
•  Administer thiamine (B1) 
• Commence intravenous rehydration and potassium, magnesium, phosphate and calcium as clinically indicated 
• Monitor patient's electrolyte levels  
• Monitor patients' vital signs and ECG 

• Discuss a place of care for the re-establishment of good nutritional status. 
Patients should receive treatment in hospital until they are medically stable, patients whose impaired nutritional status steams from an eating disorder or disordered eating pattern should then continue their treatment in a mental health facility. This will ensure the patient receives the appropriate support and care to address cognitive factors preventing the intake of nutrition and/or underlying mental illness, rather than just the physical manifestation of malnutrition. 
 

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