Function of Body Fluids - Maintain blood volume - Regulate body temperature (sweating) - Transport material to and from cells

Function of Body Fluids cont'd - Serve as medium for cellular metabolism - Assist with digestion of food - Serve as a medium for excreting waste

Fluids, Electrolytes, & Intravenous Therapies Flashcards by Kaylie Krauzyk

Composition of Body Fluid

Water

Gases

Solutes

* Electrolytes

* Nonelectrolytes

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These develop an electrical charge when dissolved in water

e.g. Na⁺, K⁺

electrolytes

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These do not conduct electricity within water

e.g. glucose

Nonelectrolytes

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The total amount of body fluid varies and is based on age, sex, and amount of adipose tissue present

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Function of Body Fluids

Maintain blood volume
Regulate body temperature (sweating)
Transport material to and from cells

Function of Body Fluids cont’d

Serve as medium for cellular metabolism
Assist with digestion of food
Serve as a medium for excreting waste

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Is body fluid that is contained within the cells

Contains ___ (potassium, magnesium) and ___ (phosphate)

Intracellular fluid

cations, anions

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Is body fluid that is found outside of the cells

Contains sodium, chloride, bicarbonate, albumin, transcellular fluids

Extracellular fluid

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Plasma in the blood; main function is to transport blood cells

Intravascular fluid

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Lies in spaces between body cells

edema - is excess fluid within this ___ space

Interstitial fluids

interstitial

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Specialized fluids contained within body spaces

e.g. CSF, peritoneal fluid, digestive secretions

Transcellular fluid

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Occurs where fluid is trapped in another compartment, not within interstitial cells or within the intravascular space

Due to low albumin levels, hypervolemia (fluid overload), decreased sodium levels

Creates a sort of generalized edema; seen in the legs, thighs, abdomen, and face

Third spacing

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Occurs when molecules move across a cellular membrane against a concentration gradient

Requires energy expenditure

Vital for maintaining the composition of both the extracellular and intracellular compartments

Active transport

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In the presence of ATP, actively moves ___ from the cell into the extracellular fluid and ___ from the extracellular fluid into the cell

Sodium-Potassium Pump

sodium; potassium

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Releases from the cell to enable substances to acquire the energy needed to pass through the cell membrane

Adenosine Triphosphate (ATP)

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Is a type of passive transport

Movement of water or other pure solute across a membrane from an area of a less concentrated solution to an area of a more concentrated solution

Solutes can be crystalloids or colloids

Osmosis

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A form of passive transport

Process where solute molecules move through a cell membrane from an area of higher concentration to an area of lower concentration

Movement occurs until the concentrations are equivalent on both sides of the membrane

Diffusion

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Is another type of passive transport

Filtration

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What is a major regulator of fluid intake?

Fluids should be non-caffeinated; no sugar added

Thirst

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Fluid Intake

Recommended Daily Intake

Men: ___ mL/day

Women: ___ mL/day

Older Adults: ___ to ___ mL/day

3,700

2,700

1,500 - 2,000

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Thirst

Increased by excessive fluid loss, excessive sodium intake, and decreased fluid intake

Thirst cont’d

Decreased by high fluid intake, fluid retention, excessive intravenous infusions, and low sodium intake

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Fluid Output

Common Sources of Fluid Loss

Urine: ~150 mL/day

Feces: ~100-200 mL/day

Skin: ~600 mL/day

Lungs: ~300 mL/day

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Is fluid loss that we do not easily perceive, not easily measured

e.g. perspiration/sweating/breathing

Insensible Fluid Loss

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Is fluid loss that is measurable and perceived

e.g. urine, diarrhea, ostomy/gastric drainage

Sensible Fluid Loss

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Hormones Affecting Fluid Regulation

Antidiuretic Hormone

Renin-Angiotensin System

Aldosterone

Thyroid Hormone

Brain Natriuretic Peptide (BNP)

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? Causes the kidneys to retain fluid; based on fluid pressures in the vascular system Triggered by fever, pain, stressor in response to opioids

Antidiuretic Hormone

? Occurs in response to decreased ECF volume Glomeruli in kidneys release ___ which converts ___ to ___ which then acts on nephrons to retain Na⁺ and H₂O Directs adrenal cortex to release aldosterone

Renin-Angiotension System renin angiotension angiotension II

? Stimulates distal tubules of kidneys to reabsorb Na⁺ and excrete K⁺; causes a passive reabsorption of H₂O

Aldosterone

? Can influence/increase cardiac output which in turn increases glomerular filtration rate and urine output

Thyroid Hormone

? Can be measured in serum samples at the bedside Used to help distinguish heart failure from pulmonary edema (both are issues that can affect fluid regulation and fluid overload)

Brain Natriuretic Peptide (BNP)

Fluid Volume Deficit (\_\_\_) Loss of fluid and electrolytes from the extracellular fluid Body weight matters here Losing fluid, NOT fat, muscle Older adults are at the highest risk here Sudden loss of body weight of 5% (is clinically significant), 8% (is severe), 15% (is usually fatal)

Hypovolemia

? Is negative fluid balance (due to insufficient fluid intake or excess fluid loss [vomiting, diarrhea] or with fluid shifts [burns]) The first symptom of this is thirst Heart rate increases (tachycardia), blood vessel constriction - WHAT WILL THIS CAUSE? (\_\_\_)

Dehydration hypertension

? Involves rapid heart rate (tachycardia) with orthostatic hypotension; the volume loss has continued to severe levels Dry skin, dry mucous membranes, decreased skin turgor, decreased urine output, temperature increase

Hypovolemic Shock

Fluid Volume Excess (\_\_\_) Retention of sodium and water in the extracellular fluid increases osmotic pressure and causes fluids to shift *from the cells* into the ECF Results from excessive salt intake, decreased kidney function, decreased liver function, or poor pumping of the heart

Hypervolemia

Signs and Symptoms of Fluid Overload: Elevated blood pressure (hypertension), bounding pulse (4+), increased shallow respirations (tachypnea), cool and pale skin (pallor), distended neck veins (jugular vein distension), edema, crackles in the lungs (assess all lobes), dyspnea, excess peritoneal fluid (ascites)

Monitor I&O Use electronic IV pumps for fluid administration

Impact of Fluid Imbalance and Laboratory Studies \_\_\_ results in an increase in hematocrit, serum osmolality, urine osmolality, and urine specific gravity \_\_\_ results in a decrease in hematocrit, serum osmolality, urine osmolality, and urine specific gravity Key Takeaway: Can cause concentration or dilution of any bodily fluid samples

Fluid Volume Deficit Fluid Volume Excess

? This looks at the % of blood made up by cells; if less intravascular fluid, there is a greater % of cells

hematocrit

Nursing Diagnoses (Problem) Deficient Fluid Volume / Excess Fluid Volume Risk for Deficient Fluid Volume / Risk for Imbalanced Fluid Volume

Overall goal is to restore balance

Nursing Diagnoses (Etiology) [the cause]

Activity intolerance r/t excessive fluid and electrolyte loss Oral mucous membrane integrity r/t deficient fluid volume Decreased cardiac output r/t hypovolemia

Sodium (Na⁺) Primary function is to \_\_\_ Recommended Daily Intake: ___ mg/day (\_\_\_ mg/day if other health issues) Sources: table salt, cheese, milk, processed foods Normal Serum Level: ___ to ___ mEq/L Hypernatremia vs. Hyponatremia

regulate fluid volume 2,300; 1,500 135-145

? Serum sodium greater than 145 Causes: excessive sodium intake, water deprivation, increased water loss Symptoms: thirst, elevated temperature, dry mouth, dry mucuous membranes, hallucinations, irritability, _seizures_ Treatment: sodium restriction, increase water intake, IV infusions not containing sodium

Hypernatremia

? Serum sodium less than 135 Causes: diuretics, vomiting, diarrhea, excessive intake of hypotonic fluids Symptoms: anorexia, nausea, vomiting, weakness, lethargy, confusion, muscle cramps, twitching, _seizures_ Treatment: increase sodium intake, administer saline infusion, seizure precautions

Hyponatremia

Potassium (K⁺) Key electrolyte in \_\_\_ Recommended Daily Intake: ___ mg/day Sources: bananas, oranges, carrots, potatoes, tomatoes, spinach, dairy, meats Normal Serum Level: ___ to ___ mEq/L Hyperkalemia vs. Hypokalemia

cellular metabolism 4,700 3.5 - 5

? This is associated with increases in blood pressure, salt sensitivities, kidney stones, and risk of bone turnover Has also been associated with increased risk of stroke These organs eliminate excess K⁺ ?

Moderate potassium deficiency kidneys

? Serum potassium greater than 5 Causes: renal failure, potassium-sparing diuretics, acidosis, trauma, high intake Symptoms: muscle weakness, **dysrhythmias**, flaccid paralysis, intestinal colic, EKG changes Treatment: limit potassium-rich foods Rx: Kayexalate (available as an oral suspension or enema; served "best on ice")

Hyperkalemia

? Serum potassium less than 3.5 Causes: diuretics, vomiting, diarrhea, steroids, anorexia, bulimia Symptoms: fatigue, nausea, vomiting, muscle weakness, decreased GI motility, dysrhythmias, paresthesia Treatment: foods rich in potassium, potassium supplements

Hypokalemia

? Responsible for bone health, neuromuscular and cardiac function, and is an essential factor in \_\_\_ Recommended Daily Intake: ___ to ___ mg/day Sources: milk and milk products, dark green leafy vegetables, calcium fortified foods Normal Serum Level: ___ to ___ mg/dL Hypercalcemia vs. Hypocalcemia

Calcium (Ca²⁺) blood clotting 1,000 - 1,200 8.5 - 10.5

Calcium is very abundant in the body; 99% within the bones and teeth; 1% circulating in blood volume You need ___ to absorb calcium Tums i.e. calcium carbonate

Vitamin D

? Serum calcium is less than 8.5 Causes: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, vitamin D deficiency Symptoms: diarrhea, paresthesia of extremities, muscle cramps, tetany (muscle spasms), convulsions, **cardiac irritability** Treatment: encourage calcium dietary intake, supplements as needed

Hypocalcemia

? Serum calcium greater than 10.5 Causes: hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium Symptoms: muscle weakness, constipation, nausea, vomiting, polyuria, polydipsia, **bradycardia** Treatment: limit calcium intake, avoid calcium-based antacids (i.e. Tums)

Hypercalcemia

Magnesium (Mg²⁺) Mineral that is used in more than 300 biochemical reactions in the body About 1% circulating in blood volume Levels may be low in clients who have high alcohol intake Recommended Daily Intake: ___ to ___ mEq/day Sources: green vegetables, cereal grains, nuts Normal serum level: ___ to ___ mEq/L Hypermagnesemia vs. Hypomagnesemia

18 - 30 1.6 - 2.6

? Serum magnesium less than 1.6 Causes: chronic alcoholism, malabsorption, diabetic ketoacidosis Symptoms: neuromuscular irritability, disorientation, **dysrhythmias** Treatment: avoid alcohol intake, encourage foods high in magnesium, supplement if needed

Hypomagnesemia

? Serum magnesium greater than 2.6 Causes: renal failure, adrenal insufficiency, excess intake Symptoms: flushing (can happen when giving an IV)/warmth of the skin, hypotension, lethargy, hypoactive reflexes, **depressed respirations**, **bradycardia** Treatment: avoid magnesium-based antacids and laxatives, limit intake

Hypermagnesemia

Serum electrolytes are measured in a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP)

Teaching Clients to Prevent Fluid and Electrolyte Imbalances Is individualized to the client - What is the typical amount of fluid they require per day? - Are they on any medications that can increase the risk of imbalances? - At what age do adults begin to lose the thirst sensation? - How does urine color inform us of hydration status? - What should be limited in the diet? - What should be promoted in the diet? - When should the healthcare provider be contacted?

? Are fluids given any route outside of the alimentary canal (pathway from mouth to anus); not through GI tract Provide replacement fluids, sugars, electrolytes, and nutrients to clients unable to obtain orally; provide access for administration of medication Drug guides should always be checked to ensure compatability of medication and intravenous fluid, as well as between medications

Parenteral agents/preparations

Types of Intravenous Solutions

Isotonic fluids Hypotonic fluids Hypertonic fluids

? _Remain in_ the intravascular compartment Reflect *normal* blood serum and osmolality Useful for clients with ___ or \_\_\_ Commonly used: 0.9% sodium chloride (Normal Saline), Lactated Ringers **Clients at risk for fluid volume ___ must be closely monitored when they receive this fluid replacement because they may easily develop fluid overload**

Isotonic fluids hypotension; hypovolemia excess

? _Pull water out of_ the intravascular compartment and into the interstitial fluid compartment *Less than* normal blood serum osmolality Useful for ___ conditions Commonly used: 5% dextrose in water (D5W), 0.45% sodium chloride (half Normal Saline) **Administer these carefully to prevent a sudden fluid shift from the intravascular space to the cells.** **Never give to clients at risk for increased intracranial pressure as it can worsen cerebral edema.**

Hypotonic fluids hyperglycemic

? _Pull water into_ the intravascular compartment from the interstitial compartment *Greater than* normal blood serum osmolality Useful for stabilizing blood pressure, increasing water output Commonly used: D₅NS, D₅1/2NS, D₅LR

Hypertonic fluids

? Administration of essential proteins, amino acids, carbohydrates, vitamins, minerals, trace elements, lipids, and fluids via a ___ preparation Used to improve or stabilize nutritional status who cannot do so orally Composition is based on patient needs, discovered within the nutritional assessment Assess health status, age, metabolic needs Use cautiously in clients with unstable cardiovascular or fluid and electrolyte issues due to potential changes in fluid status

Parenteral nutrition

Peripheral Vascular Access Devices - Intravenous catheters (IV) are sized by their diameter - the gauge \* Smaller the diameter, larger the gauge - Peripheral Intravenous Lock (PIV) - Midline Peripheral Catheter - inserted into the antecubital and threaded up the arm

Complications of Intravenous Therapies Hematoma Infiltration Extravasation Phlebitis Local infection

Complications of Intravenous Therapies cont'd Thrombophlebitis Nerve injury Septicemia (sepsis) Fluid overload Embolus (air or catheter)

? Is a thrombosis and inflammation Edema, tenderness, palpable cord in vein Restart IV in opposite extremity

Thrombophlebitis

? Is inflammation of the vein Redness, pain, warmth, swelling May feel a palpable cord along the vein Cold to warm compresses given

Phlebitis

? Is a seepage of solution or medication into surrounding tissues Might see swelling, tenderness, hardness on client IV has moved out of the vein; occlusion may be noted on pump

Infiltration

? Is a seepage of a vesicant (can cause a lot of damage) solution in the tissues Can see blistering, tissue necrosis; pain, burning, blanching at site

Extravasation

? A localized blood mass that occurs outside of the blood vessel; looks like a bruise Apply pressure when removing the IV catheter

Hematoma

Central Venous Access Devices Advances into the superior vena cava Peripherally Inserted Central Catheters (PICC) \* Used for parenteral nutrition, chemotherapy, prolonged antibiotic use Nontunneled Central Venous Catheters \* Inserted into jugular, subclavian, femoral \* Are sutured into place \* Single, double, triple lumen (denotes how many ports come off it) \* For short term use (\<6 weeks)

Central Venous Access Devices cont'd Tunneled Central Venous Catheters \* Long term use \* Reduce risk of systemic infection Implanted Ports \* Placed surgically \* For long term use

Advantages/Disadvantages of CVAD - Accomodates highly irritating solutions - Accessible even when severe fluid depletion is present - May be used long term - Allows for parenteral nutrition (central only; NOT peripheral) - Decreased risk of phlebitis, extravasation, and infiltration - Can withdraw blood for laboratory tests (peripheral you can only draw off of when you first place it)

Advantages/Disadvantages of CVAD cont'd - Specialized training needed for insertion, management - Is treated as a minor surgical procedure - Sterile technique required for placement and dressing changes - High risks, such as sepsis, air embolus, ventricular dysrhythmias - Account for 90% of catheter-associated bloodstream infections

Regulating Intravenous Infusions Gravity flow - check hourly Volume-control set - when clients are at risk for high fluid volume loss Infusion pump - most common; absence of alarm is not absence of problem **You are responsible for maintaining the correct rate of flow and for monitoring the client's response to an infusion**

The greater the distance between the solution and the patient's heart, the faster that infusion will be Any pressure on the arm will decrease flow As BP rises, more force is needed to infuse into the vein The smaller the diameter of the catheter, the slower the infusion Remember to check tubing; peripheral IV's can become dislodged

Calculating IV Flow Rates IV infusion pumps (mL/hr) Volume (mL) / Time (hr) Example: The provider orders an intravenous fluid bolus of 750 mL Normal Saline to infuse over 2 hours What would the nurse set the pump at?

Calculating IV Flow Rates Gravity Flow = Drops Per Minute Flow Rate (mL/hr) x Drop Factor (gtts/mL) divided by time (**minutes**) Example: The provider orders an intravenous fluid bolus of 750 mL Normal Saline to infuse over 2 hours. The tubing available has a drop factor of 10 gtts/mL What would the nurse set the drops per minute to?

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Fluids, Electrolytes, & Intravenous Therapies Flashcards

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