40.1 Fluids Flashcards
The three main classes of plasma proteins
albumins, globulins, and fibrinogen
The primary hormones that regulate fluid
antidiuretic hormone
angiotensin II
aldosterone
natriuretic peptides
four organs of water loss
kidneys
skin
lungs
gastrointestinal tract
how hormones can influence fluids
1) Osmoreceptors react to an increase in osmolality (concentration).
2) the pituitary gland releases antidiuretic hormone to promote water conservation
3) renal tubules and collecting ducts become more permeable to water which causes more water to then return to the circulation and less to be excreted by the kidneys.
4) More water in the circulation dilutes the blood which decreases its osmolality.
4. 5) This reduction in urine production is temporary and cease once the blood suffiently diluted.
5) Osmoreceptors then stop releasing ADH
ADH also stimulates the thirst center to increase fluid intake.
How lungs Regulation of Acid–Base Balance
- When buffer system is not able to keep up, respiratory system and kidneys will regulate as well
- Lungs adapt rapidly to an acid–base imbalance.
- Increased levels of hydrogen ions and carbon dioxide provide the stimulus for respiration.
How Kidneys Regulation of Acid–Base Balance
- When buffer system is not able to keep up, respiratory system and kidneys will regulate as well
- Take a few hours to several days to regulate acid–base imbalance
- Generate or excrete bicarbonate ion
- Kidneys use phosphate ion to excrete hydrogen ions with phosphoric acid
- Some amino acids changed into ammonia which combines with hydrogen ions to make ammonium to rid of hydrogen ions
Fluid loss and Health History:
- Age
- Environmental factors
- Diet
- Lifestyle
- Medication
Age – very young and old most at risk. Infants have smaller fluid reserves and proportion of total body water is higher placing them at greater risk for fluid volume deficit.
Children have longer illness with fevers that increase insensible water loss. Many changes affect elderly and fluid, electrolyte and acid-base balance as outlined in box 40-3. Decreased percentage of body weight as water which increases risk of extracellular fluid volume deficit and dehydration; glomerular filtration is reduces as well as number and functional capacity of nephrons, devreaesed thirst sensation, reduces aldsosterone, decreased ability to excrete medications, etc.
Environmental factors – exercise, temperature extremes,
Diet – ask about weight loss diets, cleansing routines, recent changes in appetite, If excess fatty acids released, metablic acidosis can occus because of the release of ketones (ketosis with high protein diets). Alternative medicines, supplements,
Lifestyle – alcohol and drug use, may have impacts directly, such as alcohol use and repiratory depression, or may damage organs such as liver, kidneys and lungs.
Medication – obtain current list of all medications including OTC and herbal; box 40-5 medications that causes fluid, electrolyte and acid-base disturbances
Fluid loss and Medical History:
- Burn
- respiratory disorders
- GI disturbances
- Trauma
- Head Injury –
- Recent surgery –
- Cancer –
- cardiovascular disease –
- renal disorders
- GI disorders
Burns – greater body surface burned, greater fluid loss; plasma to interstitial fluid shift, exudate from burns, insensible water loss from water vapor and heat loss. Leakage from damaged capillaries; sodium and water shift into cells, cell damage
respiratory disorders – predispose the pt to respiratory acidosis – sedatives, or pneumonia (due to hypoventilation)
Alkalosis – hyperventilation; fever and anxiety expelling too much CO2
GI disturbances such as nasogastric suctioning or gastroenteritis (metabolic alkalosis)
Diarrhea and fistulas lead to metabolic acidosis and hypokalemia
Trauma – bleeding can causes hypovolemia; crush injuries release potassium into intravascular fluid (hyperkalemia)
Head Injury – cerebral edema can cause pressure on pituitary gland affecting secretion
Recent surgery – many changes following; fliud loss, body’s response to trauma. May not want to deep breath or cough due to pain, hypoventilation; nasogastric suction;
Cancer – depends on type and progression and treatment
cardiovascular disease – diminished cardiac output impacts kidney perfusion, retain sodium and water, circulatory overload, risk of pulmonary edema
renal disorders – kidneys key part in fluid/base/electrolytes, any issue impacts. Metabolic acidosis due to decreased renal function as hydrogen ions not excreted.
GI disorders – depends on the disorder, diarrhea, vomiting, liver failure and acites.
3 types of Vascular Access Devices
1) PVADS (traditional IV), PERIPHERAL Vascular access devices
2) CVADS, CENTRAL vascular access devices
3) midline catheters
CVAD nursing Responsibilities
Palpate
Edema, pain and tenderness
Inspect
For redness, swelling, discharge
Kinks in tubing
Presence of a securement device
Ensure dressing is completely intact (change 5-7 days)
Blanching of skin around insertion site or along vein path with infusions
Assess chest and neck for engorged veins or difficulty with movement
Flush and assess patency according to policy
Assess for signs of systemic infection (fever, chills, hypotension)
prior to accessing a CVAD, the nurse conducts a 15-second rub
Older Persons – protecting the skin and veins
• Use smallest gauge catheter possible (22-24)
• Avoid using the back of the hand
• Avoid using areas that are easily bumped
• If fragile skin and veins use minimal tourniquet pressure or place over patient’s sleeve
• More prone to vein wall rupture with insertion
• Loss of subcutaneous tissue causes veins to roll
• May require a lower insertion angle
use securement device for protection
• Multiple medications increase risk for fragile skin
• Dehydration more likely, contributes to difficult IV access
Regulating the infusion flow rate
- . IV too slow, can clot and stop flow or causes circulatory collapse in someone very ill too quickly can cause fluid overload.
- . Rapid infusion can cause death due to the rapid increase in vascular volume and the body may not be able to compensate
- infulsion set will have a calibration or drop factor in drops per millilitlre or gtt/ml. A microdrip is 60gtt/ml and a macrodrip is either 15ggt/ml or 10ggt/ml depending on manufacturer
- If you need to move the site, ensure new one is started and patent before discontinuing the old one.
Documentation of IVs
Document number of attempts and sites of insertion, insertion sites, infusion details, and patient response to insertion.
For EID, document type and rate of infusion and device identification number.
Document patient status, IV fluid and amount, and integrity and patency of system.
Report to oncoming nursing staff.
Report to health care provider any signs and symptoms of IV-related complications.
Document signs and symptoms of complications.
Complications of IV therapy
Infiltration
Phlebitis
Bleeding at venipuncture site
Phlebitis Scale
0
No symptoms
1
Erythema at access site with or without pain
2
Pain at access site with erythema and/or edema
3
Pain at access site with erythema and/or edema; streak formation; palpable venous cord
4
Pain at access site with erythema and/or edema; streak formation; palpable venous cord >2.54 cm (1 in) in length; purulent drainage
