Fluid Imbalance Flashcards
B. Extracellular –
outside the cell (2 areas) 1/3 of all body fluids 20% of body weight Circulates between the cells contains water, electrolytes and nutrients
1. Intravascular compartment – inside vessels; plasma 2. Interstitial compartment – between cells and vessels; fluid in and around the tissues
- Third spacing -
shift of fluid from intravascular space into a “third” or extra space.
- body cavity - out of the blood stream and into the interstitial space; such as a pleural effusion or ascites (excess fluid in the space between the tissues lining the abdomen and abdominal organs [the peritoneal cavity], caused by high pressure in the blood vessels of the liver [portal hypertension] and low albumin levels)
- interstitial spaces – edema (such as in ankles); from injury when there is a shift of fluid into the interstitial space – the body can’t use that fluid anymore because it’s not available in the cells
Objective 2 Discuss the Regulation of Fluid Balance in the Body
A. Thirst -
Thirst center in hypothalamus stimulated by:
1. dry mucous membranes in the mouth 2. drop in blood volume – stimulates the body to be thirsty 3. increase in serum osmolality – lab tests show this; an ( sodium level in extracellular fluid
B. Kidneys
Regulate excretion and retention of water and electrolytes
The glomerulus and nephron regulates this
GFR (glomerulus filtration rate) – lab tests that tells how well the kidney is functioning
1500-2600 mL of urine is produced each day
Renin-Angiotensin-Aldosterone System –
RAAS - Works to maintain intravascular fluid / blood balance and blood pressure - 👆thirst, 👆B/P (constricts vessels), and retains water
a mechanism in the body which gets triggered; renin is produced which stimulates angiotensin which clamps down on the vessels (controls the B/P) and the aldosterone gets stimulated which retains fluid.
Renin is produced by the kidneys; it works on the vessels to maintain B/P and the kidneys to maintain volume
Renin will 👆thirst
Renin will 👆B/P (by constricting the blood vessels)
Aldosterone will retain water(it’s a antidiuretic)
D. Antidiuretic Hormone
(ADH) – (antidiuretic = against losing fluid)
- produced in brain (hypothalamus) and stored in pituitary
- ADH’s release is triggered in response to low blood volume (if bleeding out the kidneys are stimulated to keep fluid in and to reabsorb fluid) or 👆serum osmolality. (Triggers for thirst)
Stimulates water reabsorption
FLUID IMBALANCES
Objective 1 Describe the Distribution of Fluids in the Body:
A. Intracellular
- inside the cell
2/3 of all body fluids
40% of body weight
Provide cell with nutrients and assist in cellular metabolism
Atrial Natriuretic Peptide (ANP)
-secreted by cells lining the atria in the heart as a response to overdistention
when atria stretch too far (pt in fluid overload) the ANP is stimulated causing an 👆in urine output (gets rid of extra fluid/ gets rid of sodium and water)
Fluid volume deficit
Dehydration =
Fluid volume deficit that is a decrease in intravascular, interstitial and/or intracellular body fluid
Fluid volume deficit
2. Hypovolemia
= decreased circulating blood volume and isotonic fluid loss from extracellular spaces
Etiology of dehydration:
- excessive fluid loss
- insufficient fluid intake
- fluid shifts – r
- failure of regulatory mechanisms that are supposed to help balance fluid levels
Clinical Manifestations of dehydration – by body system
- neurologic –
altered mental status- irritable, anxious, restless, confusion
- 👇alertness
- coma(severe FVD)
Clinical Manifestations of dehydration – by body system
- mucous membranes
dry, sticky
pale
longitudinal furrow on tongue, cracks
tongue can 👇in size
Clinical Manifestations of dehydration – by body system
3. skin
- turgor will be diminished (no longer brisk) – check under collar bone
- dry skin (but doesn’t apply to elderly who tend to have dry skin anyway)
- pale, cool extremities
- sunken eyeballs
Clinical Manifestations of dehydration – by body system
3. urinary –
Body weight: min urine output 0.5ml/kg body weight/hr (see pg 2 notes)
-👇urine output (oliguria)
-👆urine specific gravity (the concentrated amounts of particles in urine)
Normal SG:1.005-1.030 ⭐️dehydration SG>1.030
Clinical Manifestations of dehydration – by body system
5. cardiovascular
-👇 B/P
-Orthostatic hypotension
-Tachycardia (compensatory mechanism – compensating for ( B/P)
-Flat neck veins (r/t ( venous filling)
-👇pulse volume (won’t feel the normal +2)
-👇capillary refill time (ex. 👆from 3 seconds to 5 or 6 seconds)
-👆hematocrit (can use the hematocrit level to determine if pt is dehydrated or has fluid volume overload)
Hemoglobin : Hematocrit normal ratio is 1:3
-so 12:36 would be normal
-but 12:42 = dehydration
Clinical Manifestations of dehydration – by body system
6. musculoskeletal
- fatigue
- weakness
Clinical Manifestations of dehydration – by body system
7. metabolic processes
- increase or decrease in body temperature (if don’t have the fluid circulating, the body can’t cool off)
- Thirst
- ⭐️Weight loss⭐️- important ( 1kg (2.2lb)= 1L of fluid
Collaborative Management for dehydration
1. Assessment
a. assess all of the above clinical manifestations
b. laboratory assessment – look at lab results
hemoconcentration – 👆Hct: if pt is dehydrated their blood is concentrated because their volume is deficient; the hematocrit is going to look higher; hematocrit is a % of RBC as compared to the total volume of blood
increased osmolality (>300mOsm/Kg) -👆glucose,👆protein, 👆BUN,👆Na
Urine – urine will be concentrated and there will be an 👆specific gravity (> 1.030)
c. vital signs – 🔼B/P, orthostatic hypertension
d. intake and output
e. daily weight (most sensitive ) -1 Kg (2.2#) = 1 liter of fluid
Collaborative Management for dehydration
- Assessment
2. Fluid replacement
Collaborative Management for dehydration
Fluid Replacement
a. Oral rehydration: fluids that contain electrolytes and glucose (Gatorade, Pedialyte)
Medication – treat the underlying cause
- If vomiting, give antiemetic
- If diarrhea, give antidiarrheal
intravenous therapy:⭐️dr. Orders needs to include soln, rate, and additives.
-fluid challenge (fluid bonus)administer a specific amount of fluid over a short period of time to replace fluids; monitor pt closely
- D5W (hypotonic soln) if Na is high – given slowly over 48° to prevent cerebral swelling; the purpose is to put fluid back into the cells, but if done too rapidly the tissue swells causing confusion, etc.
- NS if Na is not elevated – going to use an isotonic soln (mean equal or like what’s in our body, such as normal saline); 0.9% sodium chloride is normal saline; given more rapidly because it doesn’t act like the D5W where it pulls water into the cells and causes swelling; this is given to pts with fluid volume deficit for both fluids and solutes that were lost r/t diarrhea, vomiting
INTRAVENOUS THERAPY
* Dr.’s orders need to include RATE, SOLUTION, and ADDITIVES (such as potassium)
A. Crystalloids -
Solutions with small molecules that flow easily from the bloodstream into cells and tissues
- Isotonic solutions
Ex. 0.9% Sodium Chloride (NS – normal saline) - Hypotonic solutions
Ex. 0.45% Sodium Chloride (1/2 NS) - Hypertonic solutions -
Ex. 5% Dextrose & 0.9% Sodium Chloride (D5 NS)
10% Dextrose in Water (D10W)
INTRAVENOUS THERAPY
⭐️Different types of IV soln⭐️
A. Crystalloids -
1. Isotonic solutions -
Any solution with a solute concentration equal to the osmolarity of normal body fluids
- concentration of so lutes in a solution of osmoles/L
- 0.9% Sodium Chloride (NS)- most common
- Lactated Ringers(LR) – similar to what is in plasma; contains sodium, potassium, calcium, chloride) not a soln ran for long periods of time, ICU pt.
- 5% Dextrose in Water (D5W) – isotonic in bag, but acts as hypotonic in body
- Dr.’s orders need to include RATE, SOLUTION, and ADDITIVES (such as potassium)
INTRAVENOUS THERAPY️⭐️Different types of IV soln⭐️
A. Crystalloids -
2. Hypotonic solutions -
Any solution with a solute concentration less than that of normal body fluids;
-draws water INTO cells from extracellular cells (out of vascular system), causes cells to swell (edema) and vessels to collapse.
Ex. 0.45% Sodium Chloride (1/2 NS) and 5% Dextrose in h2o(most common)
- Dr.’s orders need to include RATE, SOLUTION, and ADDITIVES (such as potassium)
INTRAVENOUS THERAPY ⭐️️Different types of IV soln⭐️
A. Crystalloids -
3. Hypertonic solutions -
- Any solution with a solute concentration greater than that of normal body fluid
- draws water OUT of intracellular space, into intravascular space causes cells to shrink and extracellular to expand
Ex. 5% Dextrose & 0.9% Sodium Chloride (D5 NS)-not given often
10% Dextrose in Water (D10W)-not given often
- Dr.’s orders need to include RATE, SOLUTION, and ADDITIVES (such as potassium)
INTRAVENOUS THERAPY ⭐️️Different types of IV soln⭐️
B. Colloids (plasma expanders) –
- pull fluid INTO bloodstream,
- large molecules that can’t leak into tissues; (stay into blood stream)
- used for aggressive fluid resuscitation (trauma victim – lost a lot of fluid);
- have to monitor pt for fluid overload which can cause cardiac arrest.
Ex. 1. Albumin
2. Dextran (synthetic) 3. Hetastarch (Hespan) (synthetic)
INTRAVENOUS THERAPY ⭐️️Different types of IV soln⭐️
C. Total Parenteral Nutrition (TPN and PPN)
- TPN- total Parenteral Nutrition:
Dextrose 10-25%(high concentration )
-IV with highly concentrated, hypertonic (because of all the solutes in it) nutrient solution administered through a large, central vein, close to the heart
-Provides calories, fluids & minerals, restore nitrogen balance
Must be given thru a central vein/PICC line (peripheral vein can’t tolerate anything higher than 10% dextrose or the vein will get a phlebitis)
TPN triggers:
- Debilitating illness greater than 2 weeks
- Loss of 10% or more of pre-illness weight
- Excessive nitrogen loss ( total protein and albumin)
- Nonfunction of GI tract lasting 5-7 days –if a pt needs to rest the gut he/she will need TPN, for example; severe pancreatitis, inflammatory bowel center, bowel surgery, or severe burns (need the extra calories to heal)
- Complications of TPN
a. fluid imbalances- fluid shifts between body compartments - r/t hypertonic soln
- hyperglycemia leading to diuresis (👆excretion of urine) & dehydration (pt may need insulin to control the temporary high BS caused by the high amounts of glucose he/she is receiving thru TPN)
- fluid overload and pulmonary edema – r/t hypertonic soln (fluid back up into avoli in the lungs)
b. electrolyte imbalances – daily lab draws check the levels. Monitoring sugar and electrolyte imbalance.
INTRAVENOUS THERAPY ⭐️️Different types of IV soln⭐️
C. Total Parenteral Nutrition (TPN and PPN)
- PPN- Peripheral Parenteral Nutrition
Like TPN, EXCEPT maximum of 10% dextrose in peripheral vein.
Identify Various Delivery Methods for IV Solutions
Peripheral Lines –
- used for short-term or intermittent therapy; usually use veins in arm or hand
- a short, plastic, flexible catheter is inserted into the vein
Identify Various Delivery Methods for IV Solutions
B. Central lines
IV infused into the large vein close to the heart
- Central venous catheter
- Peripherally inserted central catheter (PICC)
- Vascular access port
- Tunneled external catheters
- Hickman, Broviac or Groshong
Identify Various Delivery Methods for IV Solutions
B. Central lines
- Central venous catheter –
placed in a central vein such as subclavian, sits right above the right atria
- Short term use
- Big risk for infection
Identify Various Delivery Methods for IV Solutions
B. Central lines
- Peripherally inserted central catheter (PICC) –
Upper arm, long catheter (less chance of infection this way r/t the bacteria has a long way to travel before getting to the heart)
- left in for months at a time
- commonly used in hospital and homecare settings when venous access is difficult or treatment is prolonged
- nse can be certified in inserting PICC’s or is done in interventional radiology/ fluoroscopy.
Identify Various Delivery Methods for IV Solutions
B. Central lines
3.Vascular access port –
- Central vein under the skin close to the heart
- long-term therapy such as chemotherapy;
- access port with a 90° bent needle (Huber)
- physician placement
Identify Various Delivery Methods for IV Solutions
B. Central lines
4. Tunneled external catheters/Hickman, Broviac or Groshong –
long-term therapy (ex. Chemo, for nutrition or antibiotic therapy); tunnel deep into the skin external catheter; still a central line, but tunnels into abdomen area for easy access for pt
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
- Infiltration
- Phlebitis or thrombophlebitis
- Infection
- Hematoma
- Extravasation
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
1. Infiltration
-Catheter is dislodged from vein
-fluid leaks from the catheter into the surrounding tissue
symptoms of infiltration include:
tight, hard, swollen skin; skin is COLD to touch; painful
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
2.Phlebitis or thrombophlebitis
inflammation of the vein
Vein wall inflamed, small lumen
symptoms of phlebitis (inflammation) or thrombophlebitis (inflammation caused by a blood clot) include: pain, redness, red streak; sluggish flow; vein that is cordlike; skin may feel a little warm
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
3.Infection
-bacterial contamination at the site
symptoms of infection include:
tender, warm, redness, drainage, bacterial contamination
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
3. Hematoma –
large amount of bruising
- leaking of blood into surrounding tissue
– usually occurs during insertion or with a pt who has clotting disease
symptoms of hematoma include: pain, bruising (ecamosis)
Possible Complications of IV Therapy
Assess the pt. for Local Complications Of IV site
4. Extravasation
infiltration of a vesicant drug (causes vessels to constrict) – such as chemo, emergency B/P meds, potassium; causes a lot of damage to tissue
symptoms of extravasation include: pain, burning, swelling, blistering, possible necrosis, possible disfigurement
-interventions: stop infusion, follow agency policy, disconnect tubing & aspirate any remaining drug from catheter, call dr., administer antidote per catheter or inject into subq tissue, elevate arm, apply ice. Leave catheter in place
Possible Complications of IV
Systemic Complications (Whole body reacting)
1. Bloodstream infection -
pathogens enter the bloodstream usually resulting from poor aseptic technique
Symptoms: fever, septic shock
Possible Complications of IV
Systemic Complications (Whole body reacting)
2. Fluid overload –
admin too much fluid for the body to handle
Symptoms: 👆B/P (r/t 👆volume), 👆respiration (r/t fluid in lungs causing difficulty in O2 exchange), SOB (r/t fluid in lungs from leaking from vascular compartments to interstitial compartments); crackles (r/t fluid that has leaked into interstitial spaces)
Possible Complications of IV
Systemic Complications (Whole body reacting)
Speed shock -
too fast of IV push fluids or meds
Symptoms: facial flushing, dizziness, irregular pulse, 👇B/P, severe headache, loss of consciousness and cardiac arrest
Possible Complications of IV
Systemic Complications (Whole body reacting)
Allergic reaction -
local or general reaction to tape, cleansing agent, latex catheter, solution or medication
Symptoms: if systemic – itching, rash, wheezing, bronchospasm
