Fluids And Iv Therapy Flashcards
How much of your fluid in the body is water
60%
What affects the fluids
Age
Gender
Body fat
Where do solutes move for diffusion
Move from area of higher concentration to area with lower concentration
This results in equal distribution
Where do fluids move for osmosis
Moves from areas with lower solute concentration to areas with higher concentration
What does hydrostatic push out of the capillaries
Pushes fluid out
What organ produces hydrostatics
The heart
What does oncotic movement mean
Means fluid is being pulled out of the capillaries
What exerts oncotic pressure
Exerted by non-diffusible plasma proteins such as albumin
What is third spacing
Condition where fluid accumulates in a pocket that is not serving a purpose
What is anasarca
Severe, generalized edema marked by profound swelling of sub-q tissues and accumulation of fluid in body cavities
Where is icf
Fluid in cells
Where is the ECF
Fluid outside the cell’s:
Intravascular
Interstitial
Transcellular
What is the name for the isotonic fluid concentration
Normal saline(0.9%NaCl)
Normal saline= isotonic due to?
The same concentration of sodium in the blood
What is the hypotonic fluid concentration
1/2 normal saline
What happens to the cells when we give 1/2 n.s.
The cells swell
What is the fluid concentration for a hypertonic solution
D5 n.s.
What happens to the cells when hypertonic solution is introduced
Fluid is pulled from the cells so they shrink
What helps maintain fluid balance
Kidneys
ADH
Renin-Angiotensin-Aldosterone System (RAAS)
Aldosterone
Atrial natriuretic peptide
Thirst
What are the 7 functions of the kidneys
A-controlling ACID-base balance
W-controlling WATER balance
E- maintaining ELECTROLYTE balance
T-removing TOXINS and waste products from the body
B- controlling BLOOD PRESSURE
E- producing the hormone ERYTHROPOIETIN
D- activating vitamin D
How does ADH restore blood volume
Reducing diuresis
Increasing water retention
Vasoconstricts
What happens as the ECF decreases
Renin acts to produce angiotensin
What happens after renin produces angiotensin
Angiotensin 1 is produced which converts into angiotensin 2 which equals massive vasoconstriction
What does A2 stimulate the release of
Release of aldosterone
What is retained after this release of aldosterone
Retention of sodium and water
Aldosterone does what to water
Regulates water
What does aldosterone cause the kidneys to retain
Na and water
What causes aldosterone to be released
If Na is too low and k+ is high
Where is atrial natriuertic peptide produced and stored
In the atria
What does ANP stop
Stops action of RAAS
How does ANP decrease bp
By vasodilation
How does ANP reduce fluid volume
By increasing the secretion of Na+ and water
Thirst is regulated by
Hypothalamus
Thirst is stimulated by
Increase in ECF and drying of mucous membranes
What depletes electrolytes (VPPS)
Vomiting
Peeing
Pooping
Sweating
What causes hypovolemia
Deficit of isotonic fluid in ECF
Diuretics
Third spacing
Chronic diseases
What causes fluid deficit of isotonic fluid in ECF
Abnormal:
Fluidloss
Fever
Hemorrhage
Vomiting
Diarrhea
GI suction
Decreased fluid intake
What causes an excess of isotonic fluid in the ECF
Abnormal retention of water and sodium in about same proportions which they normally exist in ECF
Hypervolemia can cause
Isotonic fluid overload
Excess sodium intake
Heart failure, renal failure, liver cirrhosis
What are some signs of fluid deficit
Restlessness
Cold clammy skin
Decreased skin turgor
Weave, rapid heart rate
Rapid respirations
Orthostatic hypotension
Decreased urine output
What are some signs of fluid excess
Headache
Confusion
Peripheral edema
Jugular vein distention
S3 heart sound
Bounding pulse, increased bp
Dyspnea, tachycardia, crackles, pulmonary edema
Weight gain
How can we manage hypervolemia
Asses for s/s of fluid imbalance
Give iv fluids and meds as orders
O2 as ordered
Fall precautions
Daily wts
Accurate I&o
Eval edematous extremities
Encourage oral fluids when appropriate
What are the advantages of iv therapy
Replace fluid
Transfuse blood
Deliver meds
Correct electrolyte imbalances
What are the disadvantages of iv therapy
Adverse reactions
Incompatibilities
Infections
Damage
Fluid overload
Overdose
Hindrance
Potential electrolyte imbalances
Isotonic iv solutions
D5W - 5% Dextrose in water
NS - 0.9% Sodium Chloride
LR -Lactated Ringers
Hypotonic iv solutions
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
Hypertonic solutions
D5 1/2 NS - 5% Dextrose 0.45% Sodium chloride
D5NS - 5% Dextrose 0.9% sodium chloride
D5LR - 5% Dextrose Lactated Ringers
D10W -10% Dextrose in Water
Where do we start looking for an iv site
Start lower (around hand) then work up if unable to stick hand
When starting a non-trauma iv what vein is our last option
The AC
Where are iv sites to avoid
Legs, ankles, and feet
Sclerosed or thromboses veins
Veins that are knotted or tortuous
Veins below an infiltrated site ov areas of phlebitis
Areas of inflammation, disease, bruising, or breakdown
Veins of surgically compromised or injured extremities
Dominant hands (if possible) and extremities with AV shunts
What considerations should we use when selecting a vein
Condition of vein
Reason for iv
What solutions/ meds will be used
What should we do before sticking
Palpate the vein
Suitable veins should be
Round
Firm
Elastic
What are 14g or 16 g good for
Trauma
Surgery
Needing rapid infusion
What is an 18g good for
Surgery
Receiving blood or caustic meds
What is the most common needle size for adults
20g or 22g
What is the most common needle for peds or adults with small and fragile veins
24g
What are complications of iv therapy
Fluid overload
Infection
Phlebitis
Infiltration
Extraversation
What are the methods of iv admin
Intermittent
Continuous
Bolus
Push
What are intermittent iv meds
Meds on scheduled dose daily or several times per day
What are continuous iv meds
iv solutions continuously
What are bolus iv meds
Specified amount of solution to be admin in a specific time frame
What are push iv meds
Specified amount of med to be admin in a specific time frame
What are the nurses responsibilities with iv sites
Assess site
Know the meds
Assess for adverse affects
Teach pt
What causes an air embolism
Solutions run dry
Air in line
Loose connections
Improper removal of CVAD
Poor technique with dressing or tubing changes
What are s/s of an air embolism
Dyspnea
Tachypnea
Lightheadedness
Palpations
Drop in bp
Weakness
Cyanosis
Expiratory wheezes
What are the nurses interventions when they know there is an air embolism
Call for help
Position pt in trendelenburg on their left side
Admin o2
Monitor vitals
Have crash cart
What are s/s of extravasation
Pain or burning @ iv site
Skin lightness @sight
Blanching and coolness of skin
Dependent edema
How can we prevent extravasation
Dilute meds as recommended
Avoid use of high pressure pumps
Assess and monitor iv site
Reach pt what to report
What causes a venous spasm
Viscous solutions
Too rapid admin
Cold or irritating solutions
What are symps of a venous spasm
Sharp pain@ iv sight
Pain radiating up the arm with the iv site
How can we prevent venous spasm
Dilute meds as recommended
Admin solutions and meds @room temp
Admin @recommended rate
Restart questionable ivs
Consider a warm compress during infusion
How do access med vials
Nurse uses syringe and blunt fill needle
How long do we clean the lumen after removing the cap and before administering the med
15 secs
What do we do after cleaning the lumen
Purge air from flush
Attach syringe
How many mLs do we flush line
9mL
What do we do after flushing line
Clean access
Then do med admin
After giving iv push med, how are we supposed to flush the line
Flush slowly for 2-3mL then vigorously for the rest of the flush
After removing post flesh for iv push med do we do
Clamp lumen
Attach new green cap
What is our drops per min for gravity infusion formula
Total volume x drop factor/ time in mins =gtts/min
mL x gtts/min = gtts/min
