Test 1 Flashcards
What is the primary fluid in humans
Water
What is the percent of fluids in the average adult
60%
What is the amount of fluid in an infant
70%
What percentage makes up elderly bodies of fluid
50-55%
What are the functions of body fluid
Maintain blood pressure
Medium for excreting waste
Transport materials in and out of cells(as well as through the body)
Medium for cellular metabolism
Maintain body temperature
Assist with food digestion
Two compartments for fluids to go
Intracelular
Extracellular
What are the spaces in extracellular
Interstitial
Intravascular
Transcellular
ICF
Intercellular fluid
Majority of all fluid in the body
ECF
Fluid found out side of the cell can be found in three spaces
In the vascular system
Interstitial between the cells
Or specialized fluids contained in body spaces.
What is it called if there is fluid found in none of the ECF spaces or ICF
Third spacing
Broad term for any fluid that is abnormal in spacing
Intravascular fluid
Fluid found in the vascular system this is the plasma in the blood.
Second smallest amount of fluid out of the 4
Transcellular fluid
Smallest portion of fluid found in the body
Specialized fluids contained in the body
CSF
What is the recommended amount of water a female should take in during the day
2700 ml/day
How much fluids should males intake in a day
3500ml/day
What percentage of fluids should come from food
20%
What are in control of thirst
Aldosterone
Hypothalamus
What is sensible fluid loss from urine in a day
1,500ml/day
What is a sensible loss of fluids from bowl movements in a day
100-200ml/day
If the loss of fluid isn’t sensible what is it
Insensible you cannot see the loss
What are the routes of insensible loss
Through skin and perspiration
While breathing exiting through the lungs to the air
If you have more fat what happens to fluid volume
The amount goes down for the total percentage
What plays a factor on total body fluid
Age older you get the less you have
Sex males have for fluid
Fat deposits the more fat you have the less fluids you’ll have
How much does your ICF contribute to your total weight
40%
What receptors activate thirst in the brain
Osmoreceptors
In what direction does water flow
Water follows the way of the higher concentration
Hydrostatic pressure
Pressure on capillary walls by fluids to leave
Oncotic pressure
Pulls fluid into the capillaries
What does oncotic pressure prevent
Particles called Colloids passing through the cell membrane
Hydrostatic pressure > oncotic pressure
Fluid enters capillaries
Sodium
135-145mg/dl
Encourages osmosis
Attracts water
Albumin role in osmosis
Maintains Intravascular oncotic pressure
Attracts water
Tonicity
Refers to the osmotic pressure gradient between two solutions
Isotonic
Same concentration as blood
Will not have fluid leave or enter a cell
Hypotonic
Less concentration in the solution than the blood. Water will follow the concentration and go to the cells
Hypertonic
Greater concentration in solution than in the blood. Fluid will leave the cells for the high concentration in the fluid
Where are osmoreceptors
Hypothalamus
ADH hormone
Released by posterior pituitary gland
Decreases urine output
Body will hold onto water
Increases blood pressures
What is renin
A hormone to retain water and sodium from the kidney
What two solutes are very water attractive
Sodium
Glucose
Too much can cause dehydration
Dehydration
Low fluid volume
Step one fluid leaves ICF of cells, cells shrink
Step two low ECF causes tachycardia, low blood pressure
Fluid excess
Holding on to fluid in the body
Hypertension
Edema
Increase urine output
Dependent edema
Edema related to the influence of gravity on the area effected
What can low oncotic pressure cause
Edema
Can be from hypoalbuminemia (protein in blood that attracts water back to the vascular system)
Mannitol
Osmotic diuretic
Decreases cerebral edema
What are the 5 most important ions
Sodium Na+
Potassium K+
Calcium Ca++
Phosphorus PO4 3-
Magnesium ++
What can cause third spacing
Burn wounds
Insensible fluid loss
Not perceived
Skin and lungs
Olguria
Less than 30ml of urine a hour
Insensible fluid loss by skin and lungs
900 ml a day
600 by skin
300ml a day by lungs
Insensible loss increases with
Wounds, burns, skin breakdown
Nursing management of fluid volume deficit
Measure I&O
Check electrolytes, CBC, urine gravity
Asses for hypotension/ weak pulse
Asses respiratory and perfusion
Asses orientation, vision, reflexes, hearing, muscle strength
Daily weight
Check for skin breakdown
Causes of dehydration
Inadequate fluid intake
No water no salt or both
Diabetes
Vomiting and diarrhea
Surgery
Trama
Burns
First symptom of dehydration
Thirst
Positive orthostatic hypotension blood pressure
Systolic change by 20
Significant weight loss
5%
10% is severe
15% is fatal
What can sodium imbalances lead to
Cerebral edema
Seizures
Who are likely to be hypomagnesiemia
Alcoholics
What are ways someone can become hypernatremic
Excess sweat with little intake
Supplements that are concentrated
Taking lithium
Burns
Diabetes
Flu like symptoms such as fever and diarrhea
What can be causes of hyperkalemia
Renal failure
GFR that’s low (below 50, 20 for example)
High creatine serum levels
Adrenal cortex insufficiency (addisons disease lack of aldosterone causes secondary hyperkalemia)
Potassium sparing diuretic
Drugs that interact with kidney such as NSAID
What can cause hypomagnesemia
Alcoholic
Positive Chvostek sign
Abusing laxatives
Malnourished
What can cause hypermagnesemia
Lithium toxicity
Taking milk of mag
Hypercalcemia
8.2-10.2mg/dl
Malignant tumors such as lymphoma
Cancer that has metastasize to bone
Theophylline toxicity
Hypocalcemia
8.2-10.2mg/dl
Pregnancy
Chronic alcoholism
Limited dairy intake
Vitamin D deficiency
Low phosphorus
Normal 2.5-4.5mg/dl
Inverse with calcium
Respiratory Alkalosis phosphate shifts to the cell
Excessive burns through water salt diuresis
Refeeding syndrome
AKI from hypovolemic event
What electrolyte imbalances can lithium cause
Hypernateremia
Hypermagnesemia
How many grades of phlebitis are there
4
What are the three routes to cause phlebitis
Mechanical
Chemical (potassium)
Bacterial
Nurse management for fluid overload
Daily weight
Fluid restriction
Measure I&O
Asses lung sounds for wet crackles (pulmonary edema)
Check LOC
Edema check
Overhydration
Too much salt intake
Too much fluid intake
Kidney failure
Heart failure
Pulmonary congestion
High BP
Bounding pulse
Tachycardia
Extended JVD
Dependent pitting edema
A nurse caring for a patient with third spacing what condition should the nurse watch for
Excessive edema
Where gravity iv’s used
Surgery pre op post op
Emergency room
Field start
When do you clear a IV pump
At start and end of shift
So you can document what was delivered during your shift
Phlebitis
Swelling, pain at the site
Caused by too large of cath
Improperly secured cath or tubing
Meds not diluted or too quick of a rate (K+)
What Can phlebitis lead to
Thrombosis
Sepsis
Phlebitis grade 0
No sighs or symptoms monitor site
Phlebitis grade 1
Redness at site with or without pain observation of site
Phlebitis grade 2
Pain at site with redness and/or edema
Stop iv consult Iv therapy
Phlebitis grade 3
Pain at access site with erythema and/or edema, streak formation along vein and palpable venous cord
Stop IV asses damage switch sides.
Phlebitis grade 4
Pain at access site. Erythema and/or edema, streak formation along vein, palpable venous cord >1 inch
Purulent drainage
Stop immediately asses site inform provider
Which site has lowest rate of phlebitis
AC elbow
Highest rate of phlebitis
Hand sites
Treatment of phlebitis
Warm compress 3 times a day
What setting has highest rates of bacterial phlebitis
Ems field starts
Emergency situations
True or false
Phlebitis can start after removing iv catheter
True
Infiltration
Can happen to any iv device
Fluids infuse to tissue
How Can infiltration happen
A fibrin sheath blocks flow causing backflow
What are signs and symptoms of infiltration
Non blanchable skin
Coolness to touch
Sharp pain
Treatment for infiltration
Time the body will reabsorb fluid
Warm compress can speed it up
Thrombosis
Clot formation in the vein
Causes of thrombosis
Venous trauma, low flow rate
Thrombosis signs
Hard to flush iv, constant iv occlusion, low flow rate.
How to prevent thrombosis
Flush before and after medication and at regular times to keep line open and clear.
Hematoma
Blood leaking out of vein pooling in tissue space.
Causing of hematoma
Wrong technique for placement. Pulling back not proceeding forward
Going all the way through vein
Steroids (makes skin tissue thin and weak)
Anticoagulants
Not enough pressure when removing iv
Venous spasm
Sudden involuntary contraction of vein
From cold infusion or irritating infusion
Cramping and pain above the site going up the arm
Can clamp down on central line when removing
Venous spasm prevention
Dilution of medicine
Proper rate
Warm up solution before infusion
Warm compress
Extravasation
Infusion of medication into tissue
Causes blisters
Necrosis
Sloughing
Phenergan
Dilantin
Dopamine
Kcl
How to prevent extravasation
Verify iv is good, flush before/after
Treat with antidote if possible
Iv complications prevention
Ask patient if it hurts
Check compatibility
Flush iv looking for swelling ease of push tissue density
What do you check after removing a iv
Check the catheter to make sure it didn’t break off
Feel for it tie off above location
Call provider
Put patient on left side to prevent going to pulmonary artery
Life threatening
How many layers do veins have?
3 layers
Inside -tunica intima. Endothelium
Middle- tunica media. Smooth muscle
Outside - tunica adventia Fineries connective tissue
Tunica intima
Single layer of endothelial cells
Inside layer of veins
What do you avoid when doing a iv on a vein
Bumps on the veins
Those are the valves
Avoid scarring
Avoid going distally from previously blown Ivs
Locations that are highly susceptible to phlebitis
Why do you avoid the side of a mastectomy
Poor lymph drainage
Best spot for iv for obese patients
Hands and forearms
Where would you start the iv
Start distally then move in
Catheter sizes
Grey 16g
Green 18g
Blood/ large volume
Pink 20g could do blood
Blue 22g
Yellow 24g peds
ABG
Arterial blood gas
Test before ABG
Allen test to check radial and ulnar artery blood flow
ABG values
PH 6.8-7.8
PaCo2 35-45 mmhg
Hco 22-28 mmhg
Tube types
Dobhoff tube for nasalduodenal feeding
Sengstaken-blakemore has a ballon for esophageal bleeding
Salem pump for continuous suction
Ewald for stomach irrigation
