IV/ Fluids Flashcards
3 factors affecting body fluid levels
Age
Gender
Body Fat
What are the 3 Homeostatic mechanisms?
Filtration
Diffusion
Osmosis
What is filtration
The movement of fluid across the cell membrane due to hydrostatic pressure
What is diffusion?
The movement of solutes (substances) from higher to lower concentration
What is Osmosis
The movement of fluid from areas of more fluid to areas to less fluid
When hydrostatic pressure is high, what happens?
It pushes fluid out of the capillaries into the tissue
What happens when the oncotic pressure is high?
The fluids are pulled from the tissue into the capillaries
What is third spacing
A condition where fluid is accumulated in a pocket that isn’t serving a purpose.
What is Anasarca
A severe, generalized edema with profound swelling and accumulation of fluid in the body cavities
The is Edema?
An accumulation of interstitial fluid within the tissues
Where is the majority of the body’s water
Inside the cells
What are the 3 divisions of extracellular fluid
intravascular
Intersititial
TransCellular
What are some examples of transcellular fluid
cerebral spinal fluid, synovial fluid, pleural fluid
What does Osmolality and Osmolarity measure in
Osmolality- Kg
Osmolarity- L
What does a high osmolarity of urine mean
More concentrated urine
What is the effects of
Isotonic solutions
Hypotonic Solutions
Hypertonic Solutions
No Fluid shift
Fluid will flow into the cells
Fluid will flow out of the cells
What are the 7 functions of the kidneys (a Wetbed)
Acid/base control
Water balance control
Electrolyte control
Toxin/waste removal
Blood pressure control
Erythropoietin
D (vitamin D synthesis
ADH restores blood volume by
Reducing diuresis
Increasing water retention
Vasoconstriction
What is the medication form of ADH
Vasopressin
What does Angiotension2 do? (2)
Vasoconstriction
Stimulates Aldosterone Release
what does Aldosterone do
Increase water and sodium retention
What does ANP do?
Ultimately lowers BP
-Stops action of RAAS
-Vasodilation
-Increases secretion of Na and water
How do they measure ANP
BNP
What lvl of BNP is abnormal
> 100
What simulates thirst?
An increase of extracellular fluid?
Where do fluids go? VPPS
Vomiting
Peeing
Pooping
Sweating
What can cause Hypovolemia
Abnormal fluid loss
Hemorrhage
Vomitting
Diaherra
GI Suction
Deceased fluid intake
Fever
Sweating
Diuretic
Third spacing
Chronic Diesease
What can cause Hypervolemia
Abnormal retention of sodium/water
Isotonic fluid overload
Heart failure
Renal failure
Liver cirrhosis
What are S/S of Hypovolemia
Restlessness/confusion
Cold, clammy skin
Decreased skin turgor
Weak, rapid HR
Rapid respirations
Orthostatic hypotension
Decreased urine output
What are S/S of Hypervolemia
Headache, confusion
Peripheral edema
Jugular vein distenion
Bounding pulse, Increased BP
Dyspnea, Tachypnea, crackles, pulmonary edema
Weight gain, 2 lbs over night or 5lbs during a week
Nursing Inventions of fluid imbalances (8)
Assess for S/S of fluid imbalances
Give IV fluids
O2 therapy
Fall precautions
Daily weights
I&Os
Elevate swelling extremites
Encourage oral fluids when appropiate
Treatment for Hypovolemic Shock
Monitor lung sounds
Monitor Vs and mental status
O2 therapy
Fluid replacement (Blood transfusion, Vasopressors)
Insertion of indwelling urinary catheters if needed
Difference between Hypovolemia and dehydration
Salt and water loss Vs just water loss ( Hypernatremia)
What are some advantages of IV therapy
The fastest delivery method
Correct electrolytes imbalance
Replace fluids
Transfuse blood
What are some disadvantages of IV therapy
Adverse reactions
Incompatibilities
Infections
Damage
Fluid overload
Overdose
Hinderance
Potentiate electrolyte imbalances
3 types of isotonic IV fluids
D5W
NS
LR
What happens of D5W when it enters the body
It becomes Hypotonic
What is the only solution that can be given with blood
NS
What electrolytes are in LR
Potassium, sodium, chloride, calcium,
What type of patient shouldn’t receive LR
anyone with renal disease
What are some hypotonic solutions
1/2NS
1/3 NS
1/4 NS
D2.5w
What are some Hypertonic solutions
D5 1/2 NS
D5NS
D5LR
D10W
Sites to avoid with starting IVs (8)
- Legs, ankles, and feet
- Sclerosed or thrombosed veins
- veins that are knotted
- Veins below an infiltrated site or phlebitis
- Areas of inflammation, disease, bruising , or breakdown
- Veins of surgically compromised or injured extremities
-Dominant hands - Extremities with AV shunts
Why use a 24 g to start an IV
Pediatric patients
Elderly patients with fragile veins
why use a a 20-22 g to start an IV
It is the most common size for adult patients
why would you use a 18 g to start an IV (3)
- Going to surgery
- Receiving blood
-caustic meds
Why would you start an IV with a 14-16 g
Trauma or surgery
5 Complications of IV therapy
-Fluid overload
- Infections
-Phlebitis
-Infiltration
-Extravasation
What is Extravasation
When caustic medication infiltrate into the surrounding tissues, resulting in damaged tissues
What four types of IV med administration
-Intermittent
- Continuous
- Bolus
-Push
6 advantages of IV medications
- Direct access to circulatory system
- Instant drug action
-Instant drug termination
-Better control
-Great for those with GI Tract limitation - Great for med that cause GI irritation
8 Disadvantages and Complications of IV meds
- Reconstitution errors
-Venous spasm
-Drug incompatibilities
-Impaired drug absorption - Speed Shock
-Chemical phlebitis
-Extravasation
-Air Embolisms
What is speed shock
A systemic reaction when too much medication is administrated in too short of a period
S/S of an air embolism
-dyspnea
-Tachypnea
-Lightheadedness
-palpitation
-drop in BP
-Cyanosis
-wheezes
-weakness
Nursing intervention for air embolisms
Call for help
Position patient in left side trendelenburg
Administer o2
Monitor vital signs
-have emergency equipment ready
S/S for extravasation (4)
-Pain or burning at IV site
- Skin tightness at site
- Blanching and coolness of skin
-Dependent edema
Prevention of Extravasation
- Dilute meds as recommended
-avoid use of high pressure pumps
-Assess & monitor IV sites - Teach patient what to report
Causes of venous spasm
-viscous solution
-Too rapid administration
-Cold or irritating solutions
Symptoms of venous spasm
-sharp pain at the IV site
-Pain radiating up the arm with the IV site
Ways to prevent venous spasm
-properly dilute med
-Admin meds at room temp
-Restart IV
Consider a warm compress during an infusion
Causes of phlebitis
-too rapid infusion
-presence of particulates matter in solution
-improper dilution or reconstitutaion
-administration of irritating meds
Ways to prevent phlebitis
-use an in-line filter for meds that do not reconstitute
- increase volume of diluation
-use a CVAD or a larger vein
-Slow the rate of the infusion down
-restart any questionable IVs
