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Fluid Balance & Intravenous Therapy Lecture Flashcards

1
Q

What percent of fluid in the body is water?
Why is fluid in the body important? (3)
What is it affected by?

A

60% of body fluid is water
1.Transports nutrients & oxygen to cells
2.Removes wastes from cells
3.Regulates body temperature
Affected: Age, Gender, Body Fat

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2
Q

What is the most accurate way to measure fluid status in a pt?

A

Daily Weights

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3
Q

(Homeostatic Mechanisms)
Hydro-static pressure: 1
Filtration: 2
Diffusion: 3
Osmosis: 4

A

1.generated by the
cardiovascular system as blood is pumped through the body’s blood vessels
2.occurs when water and solutes are transported across the cell membrane
as a result of this pressure
3.solutes (particles) move from an area of higher concentration to an area of lower concentration
4.fluid moves from areas with more fluid concentration (and fewer solutes) to areas with less fluid concentration (and more solutes)

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4
Q

Normal movement of fluids through the capillary wall into the tissues depends on 2 forces:

A
  1. Hydrostatic Pressure:(exerted by pumping of the HEART) :pushing fluid out of capillaries (vessel into tissue) (THINK HEART)
  2. Oncotic Pressure: the ‘pulling force’ pulling fluids from the surrounding tissue into the capillaries. ( THINK ALBUMIN)
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5
Q

The relationship between Hydrostatic pressure and Oncotic pressure needs to remain?

A

hydrostatic and oncotic needs to be balanced!!
HOMEOSTATIC MECHANISM

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6
Q

What is third spacing?

A

a condition where fluid accumulates in a pocket that isn’t serving a purpose (ascites )– fluids in abdominal cavity – peritonitis.

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7
Q

Is edema the same as third spacing?
causes of edema:

A

Not necessarily
1.Long periods of standing or sitting
2.Venous insufficiency
3.Chronic (long-term) lung diseases (Crackles:base of lung caused by edema)
4.CHF
5.Pregnancy
6.Malnutrition low protein

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8
Q

What is Anasarca?

A

severe swelling in the entire body… very swollen towards the end of life… due to organ failure

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9
Q

What is the sodium potassium pump?
(Maintain Homeostasis)

A

Sodium & Potassium use ATP to move in & out of cells in a form of active transport.

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10
Q

Body Fluid is divided into 2 components:

A

Fluid found inside the cells = intracellular – 2/3 of fluid
Fluid found outside the cells = extracellular – 1/3 of fluid Vascular vein interstitial tissues trans-cellular surrounding.
*To maintain balance or homeostasis fluids inside the cell must be balanced with extracellular fluid. Fluids outside the cell must be balanced with intracellular fluid

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11
Q

Osmolarity & Osmolality:

A

concentration of solutes in a fluid.

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12
Q

Looking at the osmolality between the intracellular and extracellular fluids:

A
  1. extracellular fluids increase by 2-3% osmolality increase is going to increase thirst our solutes in extracellular are higher = makes us want to drink more
  2. intracellular 10-15% change in blood volume loss
    cellular dehydration
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13
Q

Fluid Concentrations and their solutions for fluid replacement:

A
  1. Isotonic – remain intravascular – I so perfect – don’t need a change so doesn’t cause any change
    Normal Saline (0.9%NaCl)
    2.Hypotonic fluids – hippo; fluids moving into cells like a hippo: ½ Normal Saline
  2. Hypertonic – hyper = energy; make cells skinny; fluid escaping from cell
    D5 Normal Saline
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14
Q

Maintaining Balance/Fluid Balance: (7)

A

Kidneys, ADH, Renin-angiotensis-aldosterone system (RAAS), Aldosterone, Atrial Natiuretic peptide, THIRST, Lymphatic system

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15
Q

Kidneys are the King of fluid balance, how ?

A

Removes excess waste from the body
Sodium & potassium are also either filtered or reabsorbed

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16
Q

How do the kidneys regulate fluid and electrolyte balance?

A

by adjusting urine volume and the excretion of electrolytes

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17
Q

How does ADH restore blood volume?

A

Reducing Diuresis
Increasing water retention
Vasoconstriction

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18
Q

What is the medication form of ADH?

A

Vasopressin (Desmopressin)

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19
Q

Where is ADH stored and produced?

A

Produced by hypothalamus & stored in pituitary

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20
Q

ADH Vasoconstriction:

A

shrinks down blood vessels; helps raise blood pressure

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21
Q

If you lose too much fluid, how does this affect you BP?

A

lost to much fluid : low blood pressure

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22
Q

What activates RAAS?

A

cascade is initiated by a decrease in renal perfusion or a low sodium – low blood pressure can activate RAAS system or low extracellular fluid.

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23
Q

What does aldosterone do in the body?

A

helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body.

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24
Q

Too much aldosterone can cause?

A

high blood pressure and a build-up of fluid in body tissues.

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25
What is the role of atrial natriuretic peptide (ANP)?
main function is to lower blood pressure by vasodilation and to control electrolyte homeostasis.
26
How does ANP regulate blood pressure?
When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the kidney and blood vessels, and promotes salt excretion, lowers blood volume and relaxes the vessel
27
ANP reduces fluid volume by?
Increasing secretion of Na+ and water
28
What does a high BNP mean?
BNP levels go up when the heart cannot pump the way it should. The higher the number, the more likely heart failure is present and the more severe it is.
29
What is the simplest method of maintaining fluid balance? where is it regulated?
THIRST (regulated by the hypothalamus)
30
How is thirst stimulated?
Increase in ECF and drying of mucus membranes
31
What depletes electrolytes? (VPPS)
Where fluids flow electrolytes follow. Vomiting,pooping,peeing, sweating.
32
Hypovolemia (Fluid volume deficit) - Fluid deficit of isotonic fluid in extracellular space caused by: (8)
Abnormal: Fluid loss, Fever, excess perspiration, Hemorrhage, Vomiting, diarrhea, GI suction, Decreased fluid intake
33
What are some other causes of Hypovolemia? (3)
Diuretics Chronic diseases – heart failure, diabetes Third-space fluid shifts, (moving into vascular system with burns, liver dysfunction, burns, crush injuries)
34
Clinical Manifestations of Hypovolemia?
low bp, higher heart rate, pale, cold This can develop quickly, severity depends on degree of fluid loss This is decreased vascular volume!!!
35
Hypervolemia:
caused by abnormal retention of water and sodium in about the same proportions which they normally exist in ECF. (too much fluid in blood stream.)
36
Biggest indicator of Hypervolemia:
unexpected weight gain daily weight is the most accurate way to find out: after urination before food 2nd is to monitor I and O
37
conditions associated with Hypervolemia:
Heart failure, liver cirrhosis, and renal failure
38
Danger signs of Hypovolemia: (8)
1.restlessness, confusion…..coma 2.cold clammy skin 3.decreased skin turgor 4.weak, rapid heart rate 5.rapid respirations 7.orthostatic hypotension decreased urine output 8.decreased capillary refill
39
Danger signs of Hypervolemia: (8)
1.headache, confusion 2.peripheral edema 3.jugular vein distention 4.S3 heart sound 5.bounding pulse, increased BP 6.dyspnea , tachypnea, 7.crackles, pulmonary edema 8.weight gain
40
Nursing Management: (8)
1. Asses for s/s of fluid imbalance 2.Daily Weights 3.Accurate I&O 4.Give IV fluids and meds as ordered 5.O2 therapy as ordered 6. Elevate Edematous Extremities 7. Implement fall Precautions 8. Encourage oral fluids when appropriate
41
Hypovolemic Shock: (40% more of intravascular volume loss) How is it treated:
1.fluid replacement NS, LR; 2.blood transfusion; 3.vasopressor 4.oxygen therapy 5.monitor vital signs and mental status 6.insertion of indwelling urinary catheter may be necessary 7.monitor lung sounds
42
Water-loss alone is the term called?
Dehydration
43
Dehydration S/S: (7)
1.feeling thirsty. 2.dark yellow and strong-3.smelling pee. 4.feeling dizzy or lightheaded. 5.feeling tired. 6.a dry mouth, lips and eyes. peeing little, and fewer than 7.4 times a day
44
Intravenous Therapy: where is it located? where can it be placed? method/rate of delivery?
Intravenous therapy is within the vein. It can be located peripherally via a peripheral IV or centrally located via a central line. It is the fastest way to deliver fluids and medications throughout the body. works really fast and only medical way to replace fluid only way to transfuse blood
45
Advantages to IV therapy: (4)
1.Replace fluid 2.Transfuse blood 3.Deliver medication 4.Correct electrolyte imbalances
46
Disadvantages to IV therapy: (8)
1.Adverse reactions 2.Incompatibilities 3.Infections 4.Damage 5.Fluid overload 6.Overdose 7.Hindrance 8.Potentiate electrolyte imbalances
47
Isotonic solution :
remain in the intravascular compartment and do not pull fluid from other compartments – replace volume: ​​ stays in vein : fluid replacement
48
Types of Isotonic Solutions: 3
D5W: 5% dextrose in water NS: 0.9% sodium chloride LR: Lactated Ringers
49
D5W: why would you use with caution?
considered isotonic as it comes packaged – the problem is, once administered into the bloodstream, the dextrose metabolizes quickly leaving only water which is a hypotonic fluid – use with caution​​: sitting in bag when body uses it its gonna become hypotonic.
50
NS or sodium chloride: 8
used when there are issues with hypovolemia, resuscitation, shock, burn injuries, diabetic ketoacidosis, metabolic alkalosis, hypercalcemia, and mild Na+ deficits. ​
51
This is the only solution that can be given with blood and blood products :
NS or Sodium Chloride
52
Lactated Ringer (LR):
LR contains sodium, potassium, calcium and chloride – electrolytes – Used in treatment of hypovolemia, burns, fluid loss, and acute blood loss aka hemorrhage – volume expander. Because it contains potassium, this fluid should not be used in patients with renal disability.​​
53
Patients with Renal issues should not get which IV solutions?
LR
54
A hypotonic solution:
GO INTO THE CELLS : VERY CAUTIOUSLY When a patient receives a hypotonic solution, fluid shifts out of the blood vessels and into the cells and interstitial spaces where osmolarity is higher. This causes the cell to swell.​​
55
Types of hypotonic solutions: 4
1/2 NS – 0.45% Sodium chloride​ 1/3 NS – 0.33% Sodium chloride​ 1/4 NS – 0.25% Sodium chloride D2.5W – 2.5% Dextrose in Water
56
Hypertonic solution:
solutions draw fluid from the intracellular space which causes cells to shrink and expansion of the extracellular space. Supply no calories​​. Shrink the cells.
57
Hypertonic solutions may be ordered for what pt's- what does this help with?
patients postoperative because they reduce the risk of edema, stabilize blood pressure, and regulate urine output.​​
58
Hypertonic solutions have a high risk of what?
Cellular dehyration- give slowly and with caution
59
When could D10W be used?
if you had a pt on TPN or HAL. If you did not have a new bag to hang, you would hang D10W or D5 ½ NS.​​
60
Types of hypertonic solutions: 4
1.D5 ½ NS – 5% Dextrose 0.45% Sodium chloride​ 2.D5NS – 5% Dextrose 0.9% Sodium chloride​ 3.D5LR – 5% Dextrose Lactated Ringers​ 4.D10W – 10% Dextrose in Water
61
IV Cannulation considerations: 4
1.Start low and work proximally 2.Caution with fragile skin Inner wrist 3.Antecubital is the last option! 4.Take your time
62
sites to avoid with iv insertion: 6
1.Legs, ankles, and feet Sclerosed or thrombosed veins 2.Veins that are knotted or tortuous 3.Veins below an infiltrated site or areas of phlebitis 4.Areas of inflammation, disease, bruising, or breakdown 5.Veins of surgically compromised or injured extremities 6.Dominant hands (if possible) and extremities with AV shunts
63
Considerations for selecting a vein:
Condition of the veins Reason for the IV What solutions or meds will be used
64
Complications of IV therapy: (5)
1. Fluid overload: overloads circulatory system 2. Infection: local or systemic 3. phlebitis: irritation to vein, mechanical or chemical 4. Infiltration: fluid seeps into the tissue 5. Extravasation: infiltration of toxic meds: necrotizes tissue
65
IV med advantages: (6)
1. Direct access to circulatory system- instant action 2.Instant drug action and drug termination 3.Rapid treatment 4.Better control of rate 5.Great for those with GI tract limitations 6.Good for meds that irritate gastric mucosa.
66
IV Disadvantages and complications: 8
1.Reconstitution errors 2.Venous Spasm 3.Drug incompatibilities 4.Impaired drug absorption 5.Speed Shock 6.Chemical phlebitis 7.Extravasation of vesicants 8.Air embolism
67
Causes of an air embolism: 5
Solution runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing changes
68
S/S of air embolism:
Dyspnea, tachypnea, lightheadedness, palpitations, drop in BP, weakness, cyanosis, expiratory wheezes
69
interventions for air embolism: 5
Call for help Position patient in Trendelenburg on their left side Administer oxygen Monitor vital signs Have emergency equipment ready
70
s/s of extravasation: 4
1.Pain or burning at IV site 2.Skin tightness at site 3.Blanching and coolness of skin 4.Dependent edema
71
prevention of extravasation:
1.Dilute meds as recommended 2.Avoid use of high pressure pumps 3.Assess & monitor IV site 4.Teach patient what to report
72
Causes 3 and symptoms 2 of venous spam:
C : Viscous solutions Too rapid administration Cold or irritating solutions S : Sharp pain at the IV site Pain radiating up the arm with the IV site
73
Prevention techniques of venous spasms: 5
1.Dilute meds as recommended 2.Admin solutions and meds at room temperature 3.Admin at recommended rate 4.Restart questionable IVs 5.Consider a warm compress during infusion
74
Chemical Phlebitis causes: 4
1.Too rapid infusion 2.Presence of particulate matter in solution 3.Improper dilution or reconstitution when preparing meds 4.Administration of irritating meds
75
Chemical Phlebitis prevention: 5
1.Use an in-line filter for meds that do not reconstitute completely 2.Increase volume of dilution 3.CVAD or larger peripheral veins for IV site 4.Slow the rate of infusion 5.Restart any questionable IVs
76
Intermittent: Continuous: Bolus or Push: Push:
1.Medications on scheduled dose daily or several times per day 2.IV solutions continuously 3.Specified amount of solution to be administered in a specific time frame 4.Specified amount of medication to be administered in a specific time frame
77
Nurses Responsibilities:
1.Assess IV site 2.Know the medication 3.Assess for adverse effects 4.Teach the patient

IM 2 Exam 2 (2 decks)

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