Fluids Flashcards
What are some output methods of body fluids?
Kidneys
Lungs
Feces
Sweat Skin
Define filtration
Movement of water and solutes together between vascular and interstitial compartments because of hydrostatic and osmotic pressure
water/solutes move from higher net pressure to lower net pressure
Define osmosis
Passive transport of water between fluid compartments moving from an area of lower solute concentration to an area of higher solute concentration until equilibrium is achieved
Define osmolality
The concentration of solutes in body fluids
What are the 3 factors affecting fluid balance?
Fluid intake
Fluid distribution
Fluid output
Explain hypovolemia
ECF Volume DEFICIT
body fluids have decreased volume but have normal osmolarity
What can hypovolemia be caused by?
diarrhea, vomiting, sweating, kidney problems, decreased fluid intake
What are some physical assessment signs of hypovolemia?
Tented skin
Dry lips/skin
low BP
tachycardia
lightheaded/dizzy upon standing
dark, concentrated urine
What are some risk factors for hypovolemia?
Very young/old
those working in the heat
GI bugs
Explain hypervolemia
ECF Volume EXCESS
body fluids have increased volume but have normal osmolarity
What can hypervolemia be caused by?
Eating lots of salty foods (draws water out of cells)
pregnancy
heart failure
What are some physical assessment signs of hypervolemia?
swollen tissue
leg edema
high BP
pulse force 3+/4+
What kind of medications may cause hypovolemia?
Diuretics- increase urination
How does a recent surgery affect ECF volume?
Being NPO before surgery
Blood loss
Appetite decreased during recovery
physiological stress causes the body to retain fluids
How can the following affect ECF volume?
Fever
Burns
Fever: losing fluids-hypovolemia
Burns: cells explode, fluid loss-hypovolemia
How is perfusion affected and assessed in a hypovolemic patient?
Capillary refill above 3 seconds suggests poor perfusion
What are some ways that fluid volume is assessed?
Calculating Intake and Output (I&O)
Daily weights (same time, clothes)
Tenting for skin turgor
Capillary refil
Urine output
When assessing I&O, when is someone at hypervolemic risk?
When there is a Net+ of 2000mL
(2000mL intaken MORE than output)
What kind of fluid output is insensible (nonmeasurable)?
Skin and lungs
Define:
VAD
Vascular access devices
(IV access)
Explain peripheral IVs
VAD
-usually in the hand/arm
-short catheter
-lasts a couple of days
Explain Central Venous Catheters (CVC)
What are the 2 types?
VAD in which the catheter tip lies close to the heart in the central circulatory system, such as in the superior vena cava
PICC: Peripheral Inserted Central Catheter
-Upper inserted in upper arm
-Catheter reaches heart
“Port”: IVAD: Implanted Vascular Access Device
-surgically placed in chest
-Line goes into vein and then to heart (superior vena cava)
-chemotherapy/long term use
List the IV catheter sizes
14G
16G
18G
20G
22G
24G (smallest/shortest)
Where do you find the infusion rate?
How do you set the infusion rate?
How should you manage tubing and dressing?
In the medication order
Pump
Change tubing and soiled dressing regularly to prevent infection
Explain phlebitis
Symptoms?
How do you handle it?
Inflammation/irritation of the inner layer of a vein
-heat, erythema, tenderness
Stop infusion, assess, start a new line, warm moist compress, elevate extremity
Explain the difference between discontinuing an IV and stopping infusion
Discontinuing an IV: taking entire IV out
Stopping infusion: turning off whatever is going through the IV
Explain Infiltration
symptoms?
How do you handle it?
IV fluid has entered subcutaneous tissue around venipuncture site
coolness, paleness, swelling
Stop infusion, assess, discontinue, elevate extremity, warm moist or cool compress
Can an IV presenting phlebitis be saved?
Can an IV presenting Infiltration be saved?
Unsure
NO
Explain Extravasation
How should it be prevented?
A vesicant drug (tissue-damaging) drug has infiltrated the IV site and entered the surrounding tissues
Not good
Assess IV more often if the patient is receiving an IV vesicant drug
List the 3 methods of intravenous med. administration
- Infusion of large volume of IV fluid
- Injection of a bolus/small volume of med. through an existing IV infusion line (IV Push)
- “Piggyback” Infusion of a solution containing the prescribed medication and a small volume of IV fluid through an existing IV line
Explain the difference between Continuous IV fluids and saline locks
Continuous IV fluids: actively attached and pumping
Saline locked: short tube, nothing attached, last thing pushed through was saline
How should an incompatible drug be given?
Must flush the line with 10mL saline before and after medication administration
When is incompatibility not a problem?
If the IV is saline locked
What is “piggyback” also known as?
Explain it
Secondary Infusion
A small IV bag/bottle is connected to a short tubing line that links up with the upper Y-port of a primary infusion line or to an intermittent venous access
What are the steps if there are continuous fluids present and you need to give an incompatible drug?
10 mL flush
Medication
10 mL flush
-flush the same volume of saline as the medication at the same rate, then slow and steady until remaining saline is done
What are the steps if there are continuous fluids running and you need to give a compatible drug?
Give medication- no flush needed!
What are the steps if there is no continuous fluids running and you need to give a medication?
Give via Saline Lock
2-3 mL flush
Medication
2-3 mL flush
-flush the same volume as the med at the same rate, then slow and steady until remaining saline is done- ensure at least 2 mL of saline are given total regardless of med. dose
What safety measure should be done EVERY time you access the line with a syringe?
Clean the hub with an alcohol swab for at least 15 seconds every time
