ch 42 potter fluid, electrolyte, acid-base Flashcards
1
Q
electrolytes such as sodium and potassium and also have a degree of acidity.
A
Cellular fluids contain
2
Q
balances within the body maintain the health and function of all body systems.
A
Fluid, electrolyte, and acid-base
3
Q
fluid amount (volume), concentration (osmolality), composition (electrolyte concentration), and degree of acidity (pH).
A
characteristics of body fluids influence body system function because of their effects on cell function
4
Q
means water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins.
A
fluid
5
Q
have less water in their bodies than people who are lean because fat contains less water than muscle
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People who are obese
6
Q
extracellular fluid (ECF)outside the cells and intracellular fluid (ICF)inside the cells
A
Body fluids are located in two distinct compartments:
7
Q
is approximately two-thirds of total body water.
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adults ICF
8
Q
approximately one-third of total body water
A
adults ECF
9
Q
(intravascular fluid and interstitial fluid)and a minor division (transcellular fluids).
A
ECF has two major divisions
10
Q
is the liquid part of the blood (i.e., the plasma)
A
Intravascular fluid (ECF)
11
Q
is located between the cells and outside the blood vessels.
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Interstitial fluid (ECF)
12
Q
such as cerebrospinal, pleural, peritoneal, and synovial fluids are secreted by epithelial cells
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Transcellular fluid (ECF minor division)
13
Q
is a compound that separates into ions (charged particles) when it dissolves in water
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electrolyte
14
Q
sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium ions (Mg2+).
A
Cations in body fluids are
15
Q
chloride (Cl − ) and bicarbonate (HCO3–)
A
Anions in body fluids are
16
Q
salts
A
Anions and cations combine to make
17
Q
of a fluid is a measure of the number of particles per kilogram of water.
A
.Osmolality
18
Q
fluid with the same tonicity as normal blood is called
A
isotonic
19
Q
solution is more dilute than the blood
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hypotonics
20
Q
solution is more concentrated than normal blood
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hypertonic
21
Q
processes that move water and electrolytes between body compartments.
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Active transport, diffusion, osmosis, and filtration are
22
Q
requires energy in the form of adenosine triphosphate (ATP) to move electrolytes across cell membranes against the concentration gradient (from areas of lower concentration to areas of higher concentration).
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Active transport
23
Q
is passive movement of electrolytes or other particles down a concentration gradient (from areas of higher concentration to areas of lower concentration).
-diffusion of electrolytes across cell membranes requires proteins that serve as ion channels.
A
Diffusion
24
Q
Water moves across cell membranes by osmosis,a process by which water moves through a membrane that separates fluids with different particle concentrations
A
osmosis
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interstitial fluid from ICF
semipermeable cell membranes separate
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, an inward-pulling force caused by particles in the fluid.
osmotic pressure
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Fluid moves into and out of capillaries (between the vascular and interstitial compartments) by the process of
filtration
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is the net effect of four forces, two that tend to move fluid out of capillaries and small venules and two that tend to move fluid back into them.
Filtration
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is the force of the fluid pressing outward against a surface
Hydrostatic pressure
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Blood contains albumin and other proteins known as
colloids
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Blood colloid osmotic pressure, also called oncotic pressure, is an inward-pulling force caused by blood proteins that helps move fluid from the interstitial area back into capillaries.
oncotic pressure
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is strongest at the arterial end of a normal capillary
Capillary hydrostatic pressure
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is weaker, and the colloid osmotic pressure of the blood is stronger.
venous end capillary hydrostatic pressure
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Disease processes and other factors that alter these forces may cause accumulation of excess fluid in the interstitial space, known
asedema
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Inflammation is another
cause of edema
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fluid intake and absorption, fluid distribution, and fluid output
Fluid homeostasis is the dynamic interplay of three processes:
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is located within the hypothalamus in the brain
thirst-control mechanism
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is located within the hypothalamus in the brain
thirst-control mechanism
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: the skin, lungs, gastrointestinal (GI) tract, and kidneys.
Fluid output normally occurs through four organs
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synthesized by neurons in the hypothalamus that release it from the posterior pituitary gland
ADH
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volume imbalances and osmolality imbalances
two major types of fluid imbalances:
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means decreased vascular volume
| -occurs ECV deficit
hypovolemia
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—Water and Sodium Lost or Gained in Equal or Isotonic Proportions
Isotonic Imbalances
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—Body Fluids Have Decreased Volume but Normal Osmolality
Extracellular Fluid Volume Deficit
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increased osmolality (too concentrated)
-water deficit
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Hypernatremia
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loss of relatively more water than salt or gain of relatively more salt than water
Two general causes make body fluids too concentrated:
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are those of cerebral dysfunction, which arise when brain cells shrivel. Hypernatremia may occur in combination with ECV deficit; this combined disorder is called clinical dehydration.
Signs and symptoms of hypernatremia
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also called water excess or water intoxication,is a hypotonic condition.
Hyponatremia,
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excessively dilute condition of interstitial fluid causes water to enter cells by osmosis, causing the cells to swell
Hyponatremia,
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Signs and symptoms of cerebral dysfunction occur when brain cells swell
Hyponatremia,
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ECV deficit and hypernatremia often occur at the same time; this combination is called
clinical dehydration
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gastroenteritis or other causes of severe vomiting and diarrhea when people are unable to replace their fluid output with enough intake of dilute sodium-containing fluids.
Clinical dehydration is common with
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shifts Ca2+out of bone;
Parathyroid hormone
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shifts Ca2+into bone.
calcitonin
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Electrolyte intake less than electrolyte output or shift of electrolyte from the ECF into cells or bone causes
plasma electrolyte deficit
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Electrolyte intake greater than electrolyte output or a shift of electrolytes from cells or bone into the ECF causes
plasma electrolyte excess.
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abnormally low potassium concentration in the blood
Hypokalemiais
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results from decreased potassium intake and absorption, a shift of potassium from the ECF into cells, and an increased potassium output
Hypokalemiais
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diarrhea, repeated vomiting, and use of potassium-wasting diuretics
- muscle weakness
- cardiac dysrhythmias
Common causes of hypokalemia
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physiologically active form of calcium in the blood is
ionized calcium.
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Factors that cause too much ionized calcium to shift to the bound forms cause symptomatic
ionized hypocalcemia
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hypocalcemia because calcium binds to undigested fat in their feces and is excreted.
acute pancreatitis frequently develop
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results from increased calcium intake and absorption, shift of calcium from bones into the ECF, and decreased calcium output
Hypercalcemia
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abnormally high calcium concentration in the blood.
Hypercalcemiais
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(i.e., bone breakage caused by forces that would not break a healthy bone).
pathological fractures
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decreases neuromuscular excitability, (lethargic)
Hypercalcemia
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increases neuromuscular excitability,
Hypocalcemia
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abnormally low magnesium concentration in the blood.
Hypomagnesemiais
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decreased magnesium intake and absorption, shift of plasma magnesium to its inactive bound form, and increased magnesium output
Hypomagnesemiais
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increases neuromuscular excitability, (similar to hypocalcemia)
Hypomagnesemiais (signs & symp)
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abnormally high magnesium concentration in the blood
Hypermagnesemiais
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End-stage renal disease causes hypermagnesemia unless the person decreases magnesium intake to match the decreased output
Hypermagnesemiais
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decreased neuromuscular excitability, with lethargy and decreased deep tendon reflexes being most common
Hypermagnesemiais (signs and symp)
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acid production, acid buffering, and acid excretion
Acid-base homeostasis is the dynamic interplay of three processes:
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more H+ions that are present, the
more acidic is a solution.
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is 7.35 to 7.45
normal pH range of adult arterial blood
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, enzymes within cells do not function properly, hemoglobin does not manage oxygen properly, and serious physiological problems occur, including death
If the pH goes outside the normal range
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Laboratory tests of a sample of arterial blood called
arterial blood gases
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are used to monitor a patient’s acid-base balance
(ABGs) aka arterial blood gases
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is a negative logarithm of the free H+concentration, a measure of the blood’s acidity or alkalinity
pH
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is partial pressure of carbon dioxide (CO2), a measure of how well the lungs are excreting CO2 produced by cells.
PaCO2
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PaCO2 indicates excessive CO2excretion (less carbonic acid) through
hyperventilation. (PaCO2)
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Increased PaCO2indicates CO2accumulation in blood (more carbonic acid) caused by
hypoventilation (PaCO2)
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35-45 mm Hg (4.7-6 kPa)
PaCO2
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– is concentration of the base (alkaline substance) bicarbonate, a measure of how well the kidneys are excreting metabolic acids.
HCO3
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– indicates that the blood has too few metabolic acids;
Increased HCO3
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– indicates that the blood has too many metabolic acids.
decreased HCO3
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21-28 mEq/L (21-28 mmol/L)
HCO3
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80-100 mm Hg (10.7-13.3 kPa)
PaO2
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is partial pressure of oxygen (O2), a measure of how well gas exchange is occurring in the alveoli of the lungs
PaO2
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is oxygen saturation, the percentage of hemoglobin that is carrying as much O2as possible
SaO2
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is observed buffering capacity minus the normal buffering capacity, a measure of how well the blood buffers are managing metabolic acids.
Base excess
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carbonic acid and metabolic acids
Cellular metabolism constantly creates two types of acids:
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are any acids that are not carbonic acid. They include citric acid, lactic acid, and many others.
Metabolic acids
95
are pairs of chemicals that work together to maintain normal pH of body fluids
Buffers
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bicarbonate (HCO3–) buffer system, which buffers metabolic acids
The major buffer in the ECF is the
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lungs and kidneys
body has two acid-excretion systems:
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carbonic acid
lungs excrete
99
metabolic acids
the kidneys excrete
100
describes a condition that tends to make the blood relatively too acidic
acidosis
101
respiratory acidosis and metabolic acidosis.
cells produce two types of acid, there are two different types of acidosis:
102
describes a condition that tends to make the blood relatively too basic (alkaline)
alkalosis
103
respiratory alkalosis and metabolic alkalosis
two types of alkalosis:
104
arises from alveolar hypoventilation; the lungs are unable to excrete enough CO2
Respiratory acidosis
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—Excessive Carbonic Acid Caused by Alveolar Hypoventilation
Respiratory Acidosis
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bicarbonate
base
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cause the removal of HCO3–, the amount of HCO3– in the blood decreases.= identyfying specific cause HCP and laboratory calculate
anion gap
108
,a reflection of unmeasured anions in plasma
anion gap
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who are between the ages of 2 and 12 frequently respond to illnesses with fevers of higher temperatures and longer duration than those of adults
Children
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have increased metabolism and water production because of their rapid growth changes
Adolescents
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normal aging, various disease conditions, and multiple medications
Older adults experience a number of age-related changes that potentially affect fluid, electrolyte, and acid-base balances
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is a hypotonic sodium-containing fluid.
Sweat
113
Starvation diets or those with high fat and no carbohydrate content often
lead to metabolic acidosis
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hypomagnesemia, in part because it increases renal magnesium excretion
Chronic alcohol abuse commonly causes
115
as an antacid, which can cause ECV excess because of its high sodium content that holds water in the extracellular compartments
baking soda
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in which excess secretion of ADH causes hyponatremia by retaining too much water and concentrating the urine
syndrome of inappropriate antidiuretic hormone (SIADH), // occur in head injury
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In many institutions AP record oral intake but not intake through feeding or IV tubes, which are nursing responsibilities. Similarly AP often record urine, diarrhea, and vomitus output but not drainage through tubes.
-You or the AP calculates the 24-hour totals (see agency policy).
I&O delegation to AP
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when a patient has a mechanical obstruction of the GI tract, severe nausea, is at high risk for aspiration, or has impaired swallowing.
Oral replacement of fluids is contraindicated
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by mouth in a patient with ECV deficit, choose fluids that contain sodium
(e.g., Pedialyte and Gastrolyte)
120
Liquids that contain lactose or have low-sodium content are
inappropriate when a patient has diarrhea.
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1 oz (30 mL) of liquid.
fluid restriction can swallow a number of pills with as little as
122
parenteral nutrition (PN), IV fluid and electrolyte therapy (crystalloids), and blood and blood component (colloids) administration
Parenteral replacement includes
123
IV devices are called
| when the catheter tip lies in a vein in one of the extremities;
peripheral IVs
124
when the catheter tip lies in the central circulatory system
| -ex: (e.g., in the vena cava close to the right atrium of the heart)
central venous catheters (CVCs) or IVs
125
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Parenteral nutrition (PN), also called
-IV administration of a complex, highly concentrated solution containing nutrients and electrolytes that is formulated to meet a patient’s needs.
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total PN (TPN)
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isotonic, hypotonic, or hypertonic
IV solution is
127
have the same effective osmolality as body fluids. Sodium-containing isotonic solutions such as normal saline are indicated for ECV replacement to prevent or treat ECV deficit.
Isotonic solutions (IV solution)
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have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water into cells.
Hypotonic solutions
129
have an effective osmolality greater than body fluids. If they are hypertonic sodium-containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel
Hypertonic solutions
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are catheters or infusion ports designed for repeated access to the vascular system.
Vascular access devices (VADs)
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are for short-term use (e.g., fluid restoration after surgery and short-term antibiotic administration).
Peripheral catheters
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, which empty into a central (catheter tip) vein
long-term use include central catheters and implanted ports
133
for administering large volumes of fluid, PN, and medications or fluids that irritate veins.
Central lines are more effective than peripheral catheters
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bundle: hand hygiene; maximum sterile barrier precautions; chlorhexidine skin antisepsis using chlorhexidine (>0.5%) in alcohol; avoidance of the femoral vein for central venous access for adults; and placement under planned controlled conditions.
prevent CLABSI//Central Line–Associated Bloodstream Infections
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VADs; tourniquet; clean gloves; dressings; IV fluid containers; various types of tubing; and electronic infusion devices (EIDs), also calledinfusion pumps
IV equipment includes
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electronic infusion devices (EIDs), also called
infusion pumps
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; it consists of a small plastic tube or catheter threaded over a sharp stylet (needle)
VAD is called an over-the-needle catheter
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main IV fluid used in a continuous infusion flows through tubing called the
primary line.
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is a technique in which a vein is punctured through the skin by a sharp rigid stylet (e.g., metal needle).
Venipuncture
140
are to collect a blood specimen, start an IV infusion, provide vascular access for later use, instill a medication, or inject a radiopaque or other tracer for special diagnostic examinations.
purposes of venipuncture
141
physiological compromise in a patient who is dehydrated, in circulatory shock, or critically ill.
An infusion rate that is too slow often leads to further
142
causing fluid and electrolyte imbalances and cardiac complications in vulnerable patients (e.g., older adults or patients with preexisting heart disease).
An infusion rate that is too rapid overloads the patient with IV fluid,
143
, also called IV pumps or infusion pumps
Electronic infusion devices (EIDs)
144
are used occasionally with an IV solution infused by gravity to prevent accidental infusion of a large fluid volume
Nonelectronic volume-control devices
145
, the height of the container influences flow rate.
For gravity flow
146
(1) keeping the system sterile and intact; (2) changing IV fluid containers, tubing, and contaminated site dressings; (3) helping a patient with self-care activities so as not to disrupt the system; and (4) monitoring for complications of IV therapy
Line maintenance involves
147
Protective devices designed to prevent movement or accidental dislodgment of a VAD are called
catheter stabilization device
148
no more frequentlythan every 96
| -specify tubing changes every 4 hours for blood
continuous infusion tubing changes occur
149
every 24 hours because of the increased risk of contamination from opening the IV system
-blood components and every 24 hours for continuous IV lipids.
intermittent infusion changes occur
150
occurs when an IV catheter becomes dislodged or a vein ruptures and IV fluids inadvertently enter subcutaneous tissue around the venipuncture site
Infiltration
151
IV fluid contains additives that damage tissue, ex chemotherapy
extravasation
152
(i.e., inflammation of a vein) results from chemical, mechanical, or bacterial causes.
Phlebitis
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include acidic or hypertonic IV solutions; rapid IV rate; IV drugs such as KCl, vancomycin, and penicillin; VAD inserted in area of flexion; poorly secured catheter; poor hand hygiene; and lack of aseptic technique.
Risk factors for phlebitis
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air is present inside syringes, IV tubing is not primed with fluid, or connectors are not removed before use and cause air to enter a patient’s vein. It also can occur if the VAD is not clamped before changing the tubing or if the IV tubing is punctured inadvertently
Air embolism occurs when
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is the IV administration of whole blood or a blood component such as packed red blood cells (RBCs), platelets, or plasma.
Blood transfusion, or blood component therapy,
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(1) increasing circulating blood volume after surgery, trauma, or hemorrhage; (2) increasing the number of RBCs and maintaining hemoglobin levels in patients with severe anemia; and (3) providing selected cellular components as replacement therapy (e.g., clotting factors, platelets, albumin).
Objectives for administering blood transfusions include
157
are considered universal blood donors because they can donate packed RBCs and platelets to people with any ABO blood type.
O-negative blood
158
called universal blood recipients because they can receive packed RBCs and platelets of any ABO type.
AB-positive blood are
159
, which refers to another antigen in RBC membranes.
Rh factor
160
is the collection and reinfusion of a patient’s own blood
Autologous transfusion(autotransfusion)
161
(1) that blood components delivered are the ones that were ordered, (2) that blood delivered to a patient is compatible with the blood type listed in the medical record, and (3) that the right patient receives the blood.
patient safety always verify three things:
162
reveals acid-base status and the adequacy of ventilation and oxygenation
ABG analysis
