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IM 2 Exam 2 > Fluid Balance & Intravenous Therapy Lecture > Flashcards

Fluid Balance & Intravenous Therapy Lecture Flashcards

1
Q

What percent of fluid in the body is water?
Why is fluid in the body important? (3)
What is it affected by?

A

60% of body fluid is water
1.Transports nutrients & oxygen to cells
2.Removes wastes from cells
3.Regulates body temperature
Affected: Age, Gender, Body Fat

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2
Q

What is the most accurate way to measure fluid status in a pt?

A

Daily Weights

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3
Q

(Homeostatic Mechanisms)
Hydro-static pressure: 1
Filtration: 2
Diffusion: 3
Osmosis: 4

A

1.generated by the
cardiovascular system as blood is pumped through the body’s blood vessels
2.occurs when water and solutes are transported across the cell membrane
as a result of this pressure
3.solutes (particles) move from an area of higher concentration to an area of lower concentration
4.fluid moves from areas with more fluid concentration (and fewer solutes) to areas with less fluid concentration (and more solutes)

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4
Q

Normal movement of fluids through the capillary wall into the tissues depends on 2 forces:

A
  1. Hydrostatic Pressure:(exerted by pumping of the HEART) :pushing fluid out of capillaries (vessel into tissue) (THINK HEART)
  2. Oncotic Pressure: the ‘pulling force’ pulling fluids from the surrounding tissue into the capillaries. ( THINK ALBUMIN)
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5
Q

The relationship between Hydrostatic pressure and Oncotic pressure needs to remain?

A

hydrostatic and oncotic needs to be balanced!!
HOMEOSTATIC MECHANISM

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6
Q

What is third spacing?

A

a condition where fluid accumulates in a pocket that isn’t serving a purpose (ascites )– fluids in abdominal cavity – peritonitis.

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7
Q

Is edema the same as third spacing?
causes of edema:

A

Not necessarily
1.Long periods of standing or sitting
2.Venous insufficiency
3.Chronic (long-term) lung diseases (Crackles:base of lung caused by edema)
4.CHF
5.Pregnancy
6.Malnutrition low protein

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8
Q

What is Anasarca?

A

severe swelling in the entire body… very swollen towards the end of life… due to organ failure

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9
Q

What is the sodium potassium pump?
(Maintain Homeostasis)

A

Sodium & Potassium use ATP to move in & out of cells in a form of active transport.

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10
Q

Body Fluid is divided into 2 components:

A

Fluid found inside the cells = intracellular – 2/3 of fluid
Fluid found outside the cells = extracellular – 1/3 of fluid Vascular vein interstitial tissues trans-cellular surrounding.
*To maintain balance or homeostasis fluids inside the cell must be balanced with extracellular fluid. Fluids outside the cell must be balanced with intracellular fluid

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11
Q

Osmolarity & Osmolality:

A

concentration of solutes in a fluid.

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12
Q

Looking at the osmolality between the intracellular and extracellular fluids:

A
  1. extracellular fluids increase by 2-3% osmolality increase is going to increase thirst our solutes in extracellular are higher = makes us want to drink more
  2. intracellular 10-15% change in blood volume loss
    cellular dehydration
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13
Q

Fluid Concentrations and their solutions for fluid replacement:

A
  1. Isotonic – remain intravascular – I so perfect – don’t need a change so doesn’t cause any change
    Normal Saline (0.9%NaCl)
    2.Hypotonic fluids – hippo; fluids moving into cells like a hippo: ½ Normal Saline
  2. Hypertonic – hyper = energy; make cells skinny; fluid escaping from cell
    D5 Normal Saline
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14
Q

Maintaining Balance/Fluid Balance: (7)

A

Kidneys, ADH, Renin-angiotensis-aldosterone system (RAAS), Aldosterone, Atrial Natiuretic peptide, THIRST, Lymphatic system

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15
Q

Kidneys are the King of fluid balance, how ?

A

Removes excess waste from the body
Sodium & potassium are also either filtered or reabsorbed

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16
Q

How do the kidneys regulate fluid and electrolyte balance?

A

by adjusting urine volume and the excretion of electrolytes

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17
Q

How does ADH restore blood volume?

A

Reducing Diuresis
Increasing water retention
Vasoconstriction

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18
Q

What is the medication form of ADH?

A

Vasopressin (Desmopressin)

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19
Q

Where is ADH stored and produced?

A

Produced by hypothalamus & stored in pituitary

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20
Q

ADH Vasoconstriction:

A

shrinks down blood vessels; helps raise blood pressure

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21
Q

If you lose too much fluid, how does this affect you BP?

A

lost to much fluid : low blood pressure

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22
Q

What activates RAAS?

A

cascade is initiated by a decrease in renal perfusion or a low sodium – low blood pressure can activate RAAS system or low extracellular fluid.

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23
Q

What does aldosterone do in the body?

A

helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body.

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24
Q

Too much aldosterone can cause?

A

high blood pressure and a build-up of fluid in body tissues.

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25
Q

What is the role of atrial natriuretic peptide (ANP)?

A

main function is to lower blood pressure by vasodilation and to control electrolyte homeostasis.

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26
Q

How does ANP regulate blood pressure?

A

When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the kidney and blood vessels, and promotes salt excretion, lowers blood volume and relaxes the vessel

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27
Q

ANP reduces fluid volume by?

A

Increasing secretion of Na+ and water

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28
Q

What does a high BNP mean?

A

BNP levels go up when the heart cannot pump the way it should.
The higher the number, the more likely heart failure is present and the more severe it is.

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29
Q

What is the simplest method of maintaining fluid balance? where is it regulated?

A

THIRST
(regulated by the hypothalamus)

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30
Q

How is thirst stimulated?

A

Increase in ECF and drying of mucus membranes

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31
Q

What depletes electrolytes?
(VPPS)

A

Where fluids flow electrolytes follow.
Vomiting,pooping,peeing, sweating.

32
Q

Hypovolemia
(Fluid volume deficit) - Fluid deficit of isotonic fluid in extracellular space caused by: (8)

A

Abnormal: Fluid loss,
Fever, excess perspiration,
Hemorrhage,
Vomiting, diarrhea,
GI suction,
Decreased fluid intake

33
Q

What are some other causes of Hypovolemia? (3)

A

Diuretics
Chronic diseases – heart failure, diabetes
Third-space fluid shifts, (moving into vascular system with burns, liver dysfunction, burns, crush injuries)

34
Q

Clinical Manifestations of Hypovolemia?

A

low bp, higher heart rate, pale, cold
This can develop quickly, severity depends on degree of fluid loss
This is decreased vascular volume!!!

35
Q

Hypervolemia:

A

caused by abnormal retention of water and sodium in about the same proportions which they normally exist in ECF.
(too much fluid in blood stream.)

36
Q

Biggest indicator of Hypervolemia:

A

unexpected weight gain
daily weight is the most accurate way to find out: after urination before food
2nd is to monitor I and O

37
Q

conditions associated with Hypervolemia:

A

Heart failure, liver cirrhosis, and renal failure

38
Q

Danger signs of Hypovolemia: (8)

A

1.restlessness, confusion…..coma
2.cold clammy skin
3.decreased skin turgor
4.weak, rapid heart rate
5.rapid respirations
7.orthostatic hypotension
decreased urine output
8.decreased capillary refill

39
Q

Danger signs of Hypervolemia: (8)

A

1.headache, confusion
2.peripheral edema
3.jugular vein distention
4.S3 heart sound
5.bounding pulse, increased BP
6.dyspnea , tachypnea, 7.crackles, pulmonary edema
8.weight gain

40
Q

Nursing Management: (8)

A
  1. Asses for s/s of fluid imbalance
    2.Daily Weights
    3.Accurate I&O
    4.Give IV fluids and meds as ordered
    5.O2 therapy as ordered
  2. Elevate Edematous Extremities
  3. Implement fall Precautions
  4. Encourage oral fluids when appropriate
41
Q

Hypovolemic Shock:
(40% more of intravascular volume loss)
How is it treated:

A

1.fluid replacement NS, LR; 2.blood transfusion; 3.vasopressor
4.oxygen therapy
5.monitor vital signs and mental status
6.insertion of indwelling urinary catheter may be necessary
7.monitor lung sounds

42
Q

Water-loss alone is the term called?

A

Dehydration

43
Q

Dehydration S/S: (7)

A

1.feeling thirsty.
2.dark yellow and strong-3.smelling pee.
4.feeling dizzy or lightheaded.
5.feeling tired.
6.a dry mouth, lips and eyes.
peeing little, and fewer than 7.4 times a day

44
Q

Intravenous Therapy:
where is it located?
where can it be placed?
method/rate of delivery?

A

Intravenous therapy is within the vein. It can be located peripherally via a peripheral IV or centrally located via a central line. It is the fastest way to deliver fluids and medications throughout the body. works really fast and only medical way to replace fluid only way to transfuse blood

45
Q

Advantages to IV therapy: (4)

A

1.Replace fluid
2.Transfuse blood
3.Deliver medication
4.Correct electrolyte imbalances

46
Q

Disadvantages to IV therapy: (8)

A

1.Adverse reactions
2.Incompatibilities
3.Infections
4.Damage
5.Fluid overload
6.Overdose
7.Hindrance
8.Potentiate electrolyte imbalances

47
Q

Isotonic solution :

A

remain in the intravascular compartment and do not pull fluid from other compartments – replace volume: ​​ stays in vein : fluid replacement

48
Q

Types of Isotonic Solutions: 3

A

D5W: 5% dextrose in water
NS: 0.9% sodium chloride
LR: Lactated Ringers

49
Q

D5W:
why would you use with caution?

A

considered isotonic as it comes packaged – the problem is, once administered into the bloodstream, the dextrose metabolizes quickly leaving only water which is a hypotonic fluid – use with caution​​: sitting in bag when body uses it its gonna become hypotonic.

50
Q

NS or sodium chloride: 8

A

used when there are issues with hypovolemia, resuscitation, shock, burn injuries, diabetic ketoacidosis, metabolic alkalosis, hypercalcemia, and mild Na+ deficits.
​

51
Q

This is the only solution that can be given with blood and blood products :

A

NS or Sodium Chloride

52
Q

Lactated Ringer (LR):

A

LR contains sodium, potassium, calcium and chloride – electrolytes – Used in treatment of hypovolemia, burns, fluid loss, and acute blood loss aka hemorrhage – volume expander. Because it contains potassium, this fluid should not be used in patients with renal disability.​​

53
Q

Patients with Renal issues should not get which IV solutions?

A

LR

54
Q

A hypotonic solution:

A

GO INTO THE CELLS : VERY CAUTIOUSLY
When a patient receives a hypotonic solution, fluid shifts out of the blood vessels and into the cells and interstitial spaces where osmolarity is higher. This causes the cell to swell.​​

55
Q

Types of hypotonic solutions: 4

A

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

56
Q

Hypertonic solution:

A

solutions draw fluid from the intracellular space which causes cells to shrink and expansion of the extracellular space. Supply no calories​​.
Shrink the cells.

57
Q

Hypertonic solutions may be ordered for what pt’s- what does this help with?

A

patients postoperative because they reduce the risk of edema, stabilize blood pressure, and regulate urine output.​​

58
Q

Hypertonic solutions have a high risk of what?

A

Cellular dehyration- give slowly and with caution

59
Q

When could D10W be used?

A

if you had a pt on TPN or HAL. If you did not have a new bag to hang, you would hang D10W or D5 ½ NS.​​

60
Q

Types of hypertonic solutions: 4

A

1.D5 ½ NS – 5% Dextrose 0.45% Sodium chloride​
2.D5NS – 5% Dextrose 0.9% Sodium chloride​
3.D5LR – 5% Dextrose Lactated Ringers​
4.D10W – 10% Dextrose in Water

61
Q

IV Cannulation considerations: 4

A

1.Start low and work proximally
2.Caution with fragile skin
Inner wrist
3.Antecubital is the last option!
4.Take your time

62
Q

sites to avoid with iv insertion: 6

A

1.Legs, ankles, and feet
Sclerosed or thrombosed veins
2.Veins that are knotted or tortuous
3.Veins below an infiltrated site or areas of phlebitis
4.Areas of inflammation, disease, bruising, or breakdown
5.Veins of surgically compromised or injured extremities
6.Dominant hands (if possible) and extremities with AV shunts

63
Q

Considerations for selecting a vein:

A

Condition of the veins
Reason for the IV
What solutions or meds will be used

64
Q

Complications of IV therapy: (5)

A
  1. Fluid overload: overloads circulatory system
  2. Infection: local or systemic
  3. phlebitis: irritation to vein, mechanical or chemical
  4. Infiltration: fluid seeps into the tissue
  5. Extravasation: infiltration of toxic meds: necrotizes tissue
65
Q

IV med advantages: (6)

A
  1. Direct access to circulatory system- instant action
    2.Instant drug action and drug termination
    3.Rapid treatment
    4.Better control of rate
    5.Great for those with GI tract limitations
    6.Good for meds that irritate gastric mucosa.
66
Q

IV Disadvantages and complications: 8

A

1.Reconstitution errors
2.Venous Spasm
3.Drug incompatibilities
4.Impaired drug absorption
5.Speed Shock
6.Chemical phlebitis
7.Extravasation of vesicants
8.Air embolism

67
Q

Causes of an air embolism: 5

A

Solution runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing changes

68
Q

S/S of air embolism:

A

Dyspnea, tachypnea, lightheadedness, palpitations, drop in BP, weakness, cyanosis, expiratory wheezes

69
Q

interventions for air embolism: 5

A

Call for help
Position patient in Trendelenburg on their left side
Administer oxygen
Monitor vital signs
Have emergency equipment ready

70
Q

s/s of extravasation: 4

A

1.Pain or burning at IV site
2.Skin tightness at site
3.Blanching and coolness of skin
4.Dependent edema

71
Q

prevention of extravasation:

A

1.Dilute meds as recommended
2.Avoid use of high pressure pumps
3.Assess & monitor IV site
4.Teach patient what to report

72
Q

Causes 3 and symptoms 2 of venous spam:

A

C : Viscous solutions
Too rapid administration
Cold or irritating solutions
S : Sharp pain at the IV site
Pain radiating up the arm with the IV site

73
Q

Prevention techniques of venous spasms: 5

A

1.Dilute meds as recommended
2.Admin solutions and meds at room temperature
3.Admin at recommended rate
4.Restart questionable IVs
5.Consider a warm compress during infusion

74
Q

Chemical Phlebitis causes: 4

A

1.Too rapid infusion
2.Presence of particulate matter in solution
3.Improper dilution or reconstitution when preparing meds
4.Administration of irritating meds

75
Q

Chemical Phlebitis prevention: 5

A

1.Use an in-line filter for meds that do not reconstitute completely
2.Increase volume of dilution
3.CVAD or larger peripheral veins for IV site
4.Slow the rate of infusion
5.Restart any questionable IVs

76
Q

Intermittent:
Continuous:
Bolus or Push:
Push:

A

1.Medications on scheduled dose daily or several times per day
2.IV solutions continuously
3.Specified amount of solution to be administered in a specific time frame
4.Specified amount of medication to be administered in a specific time frame

77
Q

Nurses Responsibilities:

A

1.Assess IV site
2.Know the medication
3.Assess for adverse effects
4.Teach the patient

IM 2 Exam 2 (2 decks)

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