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Fluid & Electrolytes > Fluid/Electrolytes > Flashcards

Fluid/Electrolytes Flashcards

1
Q

Objectives of IV Therapy

A
  1. Provide water, electrolytes, and nutrients to meet daily needs
  2. To replace water and electrolyte deficits
  3. To provide a medium for intravenous drug admin and blood products
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2
Q

Veins

A 
Dark red blood
Slow blood return
Valves at branching
Flow toward heart
Superficial location
Multiple veins supply an area
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3
Q

Arteries

A 
Bright red blood 
Rapid, pulsating blood return
No valves
Flow away from heart
Deep location
Single artery supplies an area
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4
Q

Common Cathlon sizes

A

14-#16 - large bore for rapid infusions

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5
Q

Tips for venous dilation

A 
Arm below level of heart
Stroke arm toward heart
Apply warm compress 5-10 min
Pt clinch fist tightly
Tap vein gently
Tourniquet or BP cuff
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6
Q

Types of solutions

A

Isotonic
Hypotonic
Hypertonic

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7
Q

Isotonic solutions

A

Osmolarity 270-300ish

No cellular effect- similar tonicity of blood plasma

0.9% Normal Saline
Lactated Ringers

Volume expanders, maintain status quo, increase BP

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8
Q

Hypertonic Solutions

A

Osmolarity >300

Causes cells to shrink
Pt with cellular edema, too much fluid in cell

10% dextrose in water
D5 1/2 NS
D5NS
D5LR
3% NS
5% NS
TPN
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9
Q

Total Parenteral Nutrition

A

“Being fed through veins”
Supplies 1000cal/liter–come in 2 liter bag
Risk of infection !
🔹change tubing/IV line DAILY
🔹Monitor vitals q4h, I&O, daily weight, accu✔️,possible insulin, daily labs(electrolytes)
🔹has to be on pump, room temp, special filter

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10
Q

Infiltration

A

Definition: cannula is no longer in proper placement

IV fluids entering into surrounding tissue

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11
Q

Signs & Symptoms of Infiltration

A

Site is: edematous

Cool to touch

Color is: Pale

Pain may be present
Rate of IV may slow

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12
Q

Measure to prevent Infiltration

A

Tape cannula securely

Avoid areas of flexion

Monitor site and compare extremities

ALWAYS LISTEN TO PATIENT !

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13
Q

Treatment: Infiltration

A

Discontinue IV fluids

Elevate extremity

Apply warm compress

Restart IV in opposite extremity

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14
Q

Extravasation of IV Fluids

A

Definition: cannula is no longer in proper placement

IV medication is leaking into surrounding tissue

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15
Q

Signs and Symptoms of Extravasation

A

Cool to touch
Edema
Blanching or discoloration
Burning or discomfort

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16
Q

Treatment: Extravasation

A 
Similar to infiltration tx
Occasionally cannula left in place for admin of antidote 
Debridement
Wide excision
Grafting
Last resort : amputation
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17
Q

Prevention of Extravasation

A

Infuse irritating meds through large vein
Monitor every 5-10 minutes whenever infusing high risk meds
Do not apply pressure
LISTEN TO PATIENT

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18
Q

Manifestations of Phlebitis

A

Definition: inflammation of vein

Erythema
Warm to touch
Edema
IV rate may slow
Streak formation
Palpable venous cord
Purulent drainage
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19
Q

Treatment: Phlebitis

A

Discontinue IV fluid
Apply warm, moist compress
Monitor for signs of infection
Restart IV in opposite extremity

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20
Q

Hematoma

A

Definition: during venipuncture, the wall of the vein was punctured allowing leakage of blood into the tissues. “Vein blows”

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21
Q

Pulmonary Embolism

A

Definition: a free floating clot/substance which has moved into the venous circulation and into the right side of the heart and into the pulmonary artery

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22
Q

Signs & Symptoms of Hematoma

A

Discoloration of the site (ecchymosis)
Edema
Pain

23
Q

Treatment: Hematoma

A

Discontinue IV
Elevate extremity
Apply ice or cool compress
Restart IV in another selected site

24
Q

Signs and symptoms of pulmonary embolism

A

Sudden chest pain
Cardiac arrhythmias
Syncope
Alteration in thought processes

25
Q

Preventive measures for Embolism

A 
Infuse blood or plasma through appropriate filter
Avoid veins in lower extremities 
DO NOT FORCEFULLY FLUSH IVs
Reconstitute drugs completely
Avoid particulate matter
Use filter needle
26
Q

Circulatory Overload

A

Definition: IV fluids administered too rapidly cause an increase in venous pressure which can cause cardiac dilation and result in pulmonary edema

27
Q

Signs & Symptoms Circulatory Overload

A 
Venous distention- engorged neck veins
Dyspnea
Increased resp, pulse, and BP
Air hunger
Extreme anxiety
28
Q

Treatment: Circulatory Overload

A

🔷 Slow infusion to KVO
Elevate head of bed
Notify physician
Potential orders: admin of oxygen, IV Lasix

29
Q

Air Embolism

A

Definition: air has entered the systemic circulation. This maybe fatal if the pulmonary capillaries are blocked

30
Q

Signs & symptoms of Air Embolism

A

Sudden vascular collapse
Weak rapid pulse
Decreased BP
Loss of consciousness

31
Q

Preventive measures of Air Embolism

A

All connections of the infusion set must be secure
Do not allow a vented container to run dry
Change IV fluid when approximately 100 mL remain in the container

32
Q

Treatment: Air Embolism

A

Prime all tubing prior to admin
REMOVE SOURCE OF AIR ENTRY
🔷Turn client on LEFT side with head down
The best treatment is prevention

33
Q

Speed Shock

A

Definition: occurs when substances, especially medications, are introduced into the circulation too rapidly

34
Q

Signs and symptoms Speed Shock

A

Syncope
Shock
Cardiac arrest

35
Q

Prevention Speed Shock

A

Utilize reduced size of drop for certain medication
Utilize electronic control devices
Infuse medication at prescribed rate
Monitor rates frequently

36
Q

Septicemia

A

Definition: an invasion of microorganisms into the blood stream

37
Q

Preventive measures for Septicemia

A 
Avoid touch contamination
Change solutions every 24 hours
Change cathlon every 72-96 hours 
Change tubing every 24-72 hours 
Utilize only sterile solutions
Monitor client for signs and symptoms of infection
38
Q

Treatment: Septicemia

A 
Fluid replacement
Oxygenation
Nutritional support 
Aggressive antibiotic therapy
Maintenance of acid base balance
39
Q

Water Losses

A

10% loss of body fluid in adults is serious

20% loss of body fluid in an adult is fatal

40
Q

Sensible fluid loss

A

Can be measured

Examples: urination, emesis, blood, diarrhea

41
Q

Insensible Fluid Loss

A

Unable to be measured

Examples: sweat, expiration

42
Q

Variations of water content are dependent on 3 factors

A
  1. Gender : men have more water content, more lean muscle. women have more fat content, less water
  2. Age
  3. Lean body mass - obese at risk for fluid imbalance
43
Q

Best indicator of fluid volume is

A

🔹Body Weight

One liter of fluid weighs approx. 1 Kg or 2.2 lbs

Clients should be weighed at the same time(before breakfast after urination), same clothes, same scale

44
Q

Antidiuretic Hormone

A

“Against urine formation”
Causes a decrease in the production of urine which results in reabsorption of water via the kidneys
The stimulus for ADH secretion is an increase in blood osmolarity(concentration)

45
Q

Aldosterone

A

🔷acts as a volume regulator
Stimulated by a decrease in plasma volume or a decrease in serum sodium
Causes excretion of K and reabsorption of Na
Sodium absorption results in water reabsorption- “water follows salt”

46
Q

Electrolyte Norms.

A

Potassium - 3.5 - 5.0

Sodium 135 - 145

47
Q

Potassium

A 
Regulates metabolic activities
Important for nerve conduction
Important for muscle contraction
🔸smooth muscle
🔸skeletal muscle
🔸cardiac muscle
48
Q

Foods high in Potassium

A 
Bananas
Oranges
Baked potatoes
Spinach
Chocolate
Coffee
Dried fruits: apricots, raisins, dates
Cantaloupe
49
Q

IV potassium

A

Must be diluted- 1meq/10ml
Must be administered via IV pump/controller
Give at rate 5-10meq/hour
Patient must have adequate renal function
Monitor cardiac function and labs
NEVER GIVE IV PUSH!!

50
Q

Hyperkalemia

A

> 5.0 meq/dL

Manifestations: EKG changes, muscle weakness, diarrhea, paresthesia
Causes: renal failure, K conserving diuretics, aged bloods
Treatment: monitor labs and cardiac status, avoid foods high in K, Kayexalate, insulin/glucose, (D5W), IV lasix

51
Q

Sodium

A

Helps to maintain fluid balance
Important for nerve transmission
WATER FOLLOWS SODIUM

52
Q

Foods high in Sodium

A 
Bacon 
Lunch meat
Cheese
Canned soup
Snack foods
Condiments
53
Q

Hypernatremia

A

> 145 meq/dL

too much salt, not enough water - cells are shriveled and dry
Manifestations: Thirst, ^ Temp, dry mouth, restlessness, weakness, altered level of consciousness, seizures
Causes: water deprivation, excessive Na intake or water loss, severe diarrhea (pt. immobile, can’t communicate needs, prolonged NPO)
Treatment: low sodium diet, monitor intake and output, diuretics as indicated, hypotonic IV fluids *D51/2NS–slow and safe (gerians)

54
Q

TOO MUCH SALT=

A

Skin is flushed
Agitation
Low grade temp
Thirst

Fluid & Electrolytes (2 decks)

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