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NURS105 > Chapter 30 > Flashcards

Chapter 30 Flashcards

Fluid Needs

1
Q

dehydration

A

decrease in amount of body water

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2
Q

edema

A

swelling body tissue w/ water

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3
Q

flow rate of water in IV

A

number of drops per min (gg/min)
milliliters per hour (mL/hr)

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4
Q

graduate

A

measuring container for fluid

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5
Q

intake

A

input; amount of total fluid taken into body
- all fluid drinks and IVs
- foods liquid at room temp. (ice cream, custard, etc.)

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6
Q

intravenous (IV) therapy

A

IV / IV infusion; giving fluid through tube inserted into vein

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7
Q

output

A

amount of total fluid lost leaving body
- urine
- vomitus
- diarrhea
- wound drainage

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8
Q

how is water lost

A
  • urine / feces
  • perspiration
  • exhalation
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9
Q

pulmonary edema

A

severe edema affecting the lungs

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10
Q

common causes of dehydration ?

A
  • bleeding
  • diarrhea
  • poor fluid intake
  • diaphoresis (excess sweating)
    etc.
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11
Q

signs / symptoms of dehydration ?

A
  • low BP
  • false respiration / pulse
  • confusion / dizziness / fatigue
  • dark yellow urine
  • dry mouth / lips
  • oliguria
  • poor skin turgor
  • thirst
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12
Q

who is most at risk for dehydration ?

A

older persons, especially those w/ dementia
- offer water often

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13
Q

I&O record

A

written account of intake and output measured in mL

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14
Q

special fluid order

A

care plan to adhere to persons fluid needs

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15
Q

encourage fluids fluid order

A

person drinks an increased amount of fluid
- dehydration
- UTI / kidney stones
offer fluids / keep fluids within reach

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16
Q

restrict fluids fluid order

A

fluids limited to certain amount
- edema
- kidney / heart failure
small amount / containers / no container in sight

17
Q

NPO fluid order

A

cannot eat / drink anything by mouth
- before / after surgery
- before some procedures
- treat certain illnesses
NPO sign above bed, used 6-12 hours before surgery / tests

18
Q

thickened fluids fluid order

A

all liquids thickened by dietary department
- dysphagia

19
Q

normal fluid requirements for adults

A

1500mL to survive
2000-2500mL for normal fluid balance

20
Q

measuring intake

A

subtract leftover mL of fluid from mL served

21
Q

measuring output

A

measure liquid (urine usually) in measuring device (graduate)

22
Q

shift-total (sub-total)

A

I&O calculated at the end of the shift
- add up total mL of all input / output during your shift

23
Q

total I&O

A

total input / output from past 24 hours
- add up total mL of all input / output during all shifts

24
Q

how to properly measure output in a graduate ?

A

read at eye lvl
- some state competency tests require rounding up to nearest 25 mL

25
what is the difference of a measuring container (graduate) ?
subtraction of the two labeled numbers above / below fluid level (between 400 and 300, difference = 100)
26
what info do you need when measuring I&O ?
- special fluid orders - hourly / end-of-shift report - what is used to void - if person has catheter
27
when and how should water be given if there is no special fluid orders ?
during each shift when water cup is empty - ask how much ice they want - if person uses a straw
28
how is the fluid drips from IV bags regulated
a clamp
29
what is left in the vein after inserting IV needle ?
a venous catheter / intravenous cannula
30
how can flow rate change ?
- position changes - kinked tubes - lying on tube never change clamp position / adjust controls of IV pump
31
how to manually measure IV fluid rate ?
count number of drops per for 1min (gtt/min) - tell nurse if no drips - drips too fast / too slow - IV bag is empty / close to being empty
32
how do CNAs manage IV therapy ?
they do not; - never start / maintain IV therapy - never regulate blood flow / change IV bags - never give blood / IV drugs only observe to ensure everything okay and report / record to nurse
33
safety measures of IV therapy ?
- IV site clean / dry - protect site during showering / walking by covering - do not move catheter - restraints are last resort to prevent catheter movement - never pull on IV
34
IV therapy gown
can change the gown for all IVs - snaps along sleeve
35
standard gown
can change gown if electric pump is not being used - if electric pump is used, nurse handles IV arm
36
why would IV pump alarm sound ?
tell nurse at once - air in tubing - infusion is done - pump battery is low - fluid flow is blocked
37
oz to mL
1 oz = 30 mL
38
cc to mL
1 cc = 1 mL

NURS105 (43 decks)

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