IV fluids Flashcards
Fluids: Approximately ____ of the typical adult is fluid. Varies with age, ____ ____ and gender
60%; body size
Fluids: Intracellular Fluid: Extracellular fluid (EFC): 1. ______ 2.______ 3. ______
- intravascular 2. interstitial 3. transcellular
Fluid and Electrolyte Balance: Necessary for life and __________. Nursing role is to help ______ and treat fluid and electrolyte disturbances.
Homeostasis; prevent
Name the 7 Functions of Fluids.
- maintain blood volume 2. help regulate temperature 3. transports materials to and from cells 4. Medium for cell metabolism 5. assists in food digestion trough hydrolysis 6. solvent in which solutes are available for cell function 7. medium for excreting waste
Electrolytes: Active chemicals that carry positive (cations) and negative (anions) electrical charges. Electrolyte concentrations differ in the fluid compartments. What are the 5 major Cations?
- Sodium 2. Potassium 3. Calcium 4. Magnesium 5. Hydrogen ions
Electrolytes: Active chemicals that carry positive (cations) and negative (anions) electrical charges. Electrolyte concentrations differ in the fluid compartments What are the 4 major Anions?
- chloride 2. Bicarbonate 3. phosphate sulfate 4. proteinate ions
Regulation of Fluid: Movement of fluid through capillary walls depends on what? 1. ______ ______ 2. ______ ______
- Hydrostatic pressure- pressure exerted on the walls of blood vessels 2. Osmotic pressure- pressure exerted by the protein in the plasma
Regulation of Fluid: The direction of fluid movement depends on the differences of ______ and ______ pressure
hydrostatic; osmotic
Regulation of fluid: what are considered passive transport? 1._____ 2._____ 3._____
- osmosis 2. diffusion 3. filtration
Regulation of fluid: What is active transport?
movement against the concentration gradient
Osmosis: Movement of fluid from an area of _____ solute (particles) concentration to an area of _____ concentration.
lower; higher
Diffusion: Movement of molecules and ions (solutes) from an area of ______ particle concentration to an area of _____ concentration.
higher;lower
Filtration: Movement of water and solutes from an area of ______ hydrostatic pressure to and area of _____ hydrostatic pressure.
higher; lower
Active transport: Physiological pump that moves fluid from an area of ______ concentration to one of _______ concentration. Movement _______ the concentration gradient.
lower; higher; against
Active transport: Sodium-Potassium pump maintains the higher concentration of extracellular sodium and intracellular potassium. Requires _______ (____) for energy
sodium; potassium; adenosine (ATP)
Routes of Gains & Losses: What two ways can you gain water? 1. 2.
- Dietary intake of fluid and food or enteral feeding 2. Parenteral fluid
Routes of Gains & Losses: Name the two ways to lose electrolytes. 1. 2.
- Sensible- urine, BM 2. Insensible- skin (500cc/day), bowels (100-200cc/day), Lungs (300-500cc/day)
Visual of Gains and losses of water. take at least 15 seconds to review. 😁
name the gains and losses
Fluid spacing:
What spacing is normal distribution?
First spacing
Fluid Spacing:
What spacing is abnormal accumulation of interstitial tissue, and can be easily exchanged with ECF?
Second Spacing
Example: swelling in the feet after a long day, and after you prop your feet up the swelling will go down.
Fluid Spacing:
What spacing is fluid accumulation in body that is not easily exchanged with ECF?
Third Spacing
Examples: Ascites, pericardium, and lungs.
Geriatric considerations for fluids:
What homeostatic mechanisms are reduced?
1.
2.
3.
- cardiac
- renal
- respiratory function
Geriatric considerations for fluids: fill in the blank
________ body fluid percentage
decreased
Geriatric condiserations for fluids:
What are two medication types that can influence fluids in the geriatic population?
- Blood pressure meds
- Diuretics
Fluid volume imbalances:
Hypovolemia is associated with what fluid volume imbalance?
Fluid Volume Deficit (FVD)
Fluid volume imbalances:
Hypervolemia is associated with what fluid volume imbalance?
Fluid Volume Excess (FVE)
Fluid Volume Deficit:
Loss of extracellular fluid exceeds intake ratio of water. __________ are lost in the same proportions as they exist in normal body fluids. _________ referes to loss of water alone with increased serum sodium level.
Electrolytes; dehydration
Fluid Volume deficit:
May occur in combination with other imbalances. Name 6 causes for FVD.
- fluid loss from vomiting
- diarrhea
- GI suctioning
- sweating
- decreased intake
- inability to gain access to fluid
Fluid Volume Deficit:
What are 6 risk factors for FVD?
- diabetes insipidus
- adrenal insufficiency
- osmotic diuresis
- hemorrhage
- coma
- third space shift
Functioning IV therapy:
What are the three types of IV therapy?
Maintenance
Replacement
Restoration
Funtions of IV Therapy: Maintenance
Mainly for those who are _____ and/or ______. (Remember insensible loss.) ______cc fluid/sq meter of body serface.
NPO; stressed 1500
Function of IV therapy: Maintenance
For maintenance fluids what is given and why?
glucose, Na+, K+, H20
Maintenance supplies calories, sparing protein, minimized ketone formation.
Function of IV therapy: Replacement
Replacement therapy is used for long term ____. Usually D/C’d in ___ hours. Replaces fluids when body can’t maintain requirements. Will probably need ______
NPO; 48; potassium
Function of IV therapy: Replacement
What people will need replacement therpay?
GI surgeries, N/V, diarrhea, tissue injuries, major surgeries, wound infection.
Function of IV therapy: Replacement
As nurses what should we look for?
Check Urine and output >30ml/hr for 48hrs
Function of IV therapy: Restoration
Used for restoration on ongoing basis- greater than ___hrs. Similar to replacement except need: strict _____, daily labs for _________. type of fluids depends on type _____
48; I&Os, electrolytes; lost
Function of IV therapy: Restoration
Who may need restoration therapy?
people with abscesses, NG tube, burns, large abd wounds.
Factors affecting IV therapy:
Name 5 things that may affect IV therapy.
- age- elderly, babies (#1)
- health status
- fluid balance
- development of complications- draining wounds
- equipment-pump, controller
IV influencing Factors:
What are the 4 influencing factors?
- Nurse practice act- only RNs can hang blood
- institutional guideline- read guidlines at facility
- centers for disease control (CDC)
- IV Nurses Society- set rules
Vascular Access devices:
- Peripheral
- Midline
- Peripherally inserted Central Venous Catheter (PICC)
- Central venous catheter (CVC)
- Short term non-tunneled
- Long term tunneled
- hickman, broviac
- implanted port
- groshong
- Others: dialysis, intraoscous (inside bone), intrathecal
Some meds can damage the veins and must be administered through other routes instead of the normal IV peripheral route. PICC line removal you will use a slow stop/start method, an antibacterial cream may be used. It must also be measured after to ensure it was removed intact. If it is not intact upon removal must notify MD so an x-ray must be done to find the remaining catheter that may be inside the body.
PICC line placement: take 15 seconds to review image. A PICC is advanced through the cephalic or basilic vein to the axillary, subclavian or brachiocephalic vein or the superior vena cava
Tunnel: take 15 secs to study image.
Portacath: take 15 sec to study image
IV Solutions:
Name the 3 cystalloid solutions:
- hypotonic
- isotonic
- hypertonic
IV solutions:
What are exapanders? name them.
Colloids; blood, albumin, hespan
Solutions: hypotonic (<250 mOsm/L)
Action: hydrates cell by pulling H20 into ______ spaces from _______ space.
cellular; vascular
Solutions: Hypotonic (<250 mOsm/L)
Indication: treatment of ______ dehydration.
Concerns: may exaggerate _______ due to fluid shifting out of vascular space.
What patient would we NOT give this to?
hypertonic; hypotension
ANS: Brain injury it can cause cerebral edema, we would give manitol
Solutions: Isotonic (250-375 mOsm/L)
Action: hydrates ________ compartment; replaces volume without disrupting ________ and ________ volumes.
intravascular;intracellular; interstitial
Indications: treatment of ______ dehydration. replaces ____
vascular;NaCl
IV solutions: Isotonic (250-375 mOsm/L)
concerns: use cautionusly in patients who are fluid-______ or who would become compromised if vacular volume would _______ such as cardiac/renal patinets.
overloaded; increase
