Unit 11: Fluid, electrolytes, and IV therapy

Question 1

Function of body fluid

Answer 1

• Building of body cells and tissues
• Tx of nutrients, electrolytes
• Carrying waste products from cells
• Regulation of body temp (sweating)
• Lubrication of joints and membranes
• Medium for food breakdown and digestion

Question 2

2 types of fluid

Answer 2

• Intracellular

- Extracellular

Question 3

What is extracellular plasma made of?

Answer 3

• Plasma: 3L
• Interstitial: 10 L
• Intracellular: 28 L

Question 4

Solution

Answer 4

A mixture of solutes dissolved in a solvent

Question 5

Osmosis

Answer 5

Movement of water through semipermeable membrane.

Question 6

Osmotic pressure

Answer 6

Pressure needed to stop osmotic flow of water.

Question 7

Osmolality

Answer 7

Solute concentration by weight of solvent.

Question 8

Tonicity

Answer 8

Concentration of solutes dissolved into a solution, determines the direction and extent of fluid diffusion.

Question 9

Crenation

Answer 9

shrink

Question 10

Electrolyte

Answer 10

Substances whose molecules dissociate or split into ions when placed in solution.

Question 11

Ions

Answer 11

Electrically charged particles

Question 12

Cations

Answer 12

Positively charged ions

Question 13

Anions

Answer 13

Negatively charged ions.

Question 14

What anions and cations are present within the plasma?

Answer 14

Ca, K, Mg, Cl, HCO3, negatively charged proteins, other, and PO4

Question 15

What anions and cations are present within the Intracellular?

Answer 15

K, Na, Mg, PO4, negatively charged proteins, HCO3, Cl

Question 16

K

Answer 16

• Muscle and nerve impulses
• ICK cation
• Maintains cardiac rhythm
• Acid-base balance
• Promotes cellular growth

Question 17

Na

Answer 17

• ECF cation
• Controls H2O distribution between ECF and ICF
• Generation and transmission of nerve impulses
• Acid-base balance

Question 18

Ca

Answer 18

• Transmission of nerve impulses
• Myocardial and other muscle contractions
• Blood clotting
• Formation of bones and teeth.

Question 19

Mg

Answer 19

• Coenzyme in carb and protein metabolism
• Metabolism of nucleic acids
• Helps maintain cardiac function

Question 20

Cl

Answer 20

• Acid-base balance
• ECF anion
• Water balance
• Part of gastric acid for digestion and activation of enzymes

Question 21

PO4

Answer 21

• ICF anion
• Muscle, RBC, and nervous system Fx
• Formation of bones and teeth with calcium
• Acid-base balance
• Mitochondrial energy production of ATP
• Cellular uptake and use of glucose
• Metabolism of carbs, proteins, and fats

Question 22

Subjective data

Answer 22

• PMHx (disorders)
• Meds
• Surgery and/or treatments (dialysis, ostomy, GI Sx)
• Diet (Fad diets and prescribed diets)
• Elimination patterns (Nocturia, polyuria, and diarrhea)
• Exercise patterns (Replenishing electrolytes)
• Changes in sensation, muscle weakness, mentation, or alertness.

Question 23

Objective data: Physical examination

Answer 23

• VS
• Integumentary system
• Respiratory system
• MSK
• Behaviour and mental state

Question 24

Objective data: Lab values

Answer 24

• Serum electrolytes, renal panel
• U/A
• ABG

Question 25

Correcting imbalances: Oral fluid and electrolyte replacement

Answer 25

- Mild imbalances | - Solutions containing H2O, electrolytes, and glucose

Question 26

Correcting imbalances: IV fluids

Answer 26

- Peripheral IV | - Central venous access device (CVAD): thread into superior vena cava

Question 27

What are IV fluids used for?

Answer 27

- Correct fluid and electrolyte balance - Administer meds - Diagnostic tests or anesthesia - Correct or maintain code status

Question 28

Types of IV fluids: Isotonic solutions

Answer 28

- Fluid replacement | - Can cause fluid overload in patient with renal or cardiac disease

Question 29

Types of IV fluids: Hypotonic solutions

Answer 29

- Causes movement of H2O from ECF to ICF - Can cause hemolysis of RBCs and cerebral edema - Used for fluid maintenance

Question 30

Types of IV fluids: Hypertonic solutions

Answer 30

- H2O from ICF into ECF - Increase risk for heart failure and intracellular dehydration - Used to treat hypovolemia and decrease Na

Question 31

Names, tonicity and functions of IV fluids

Answer 31

- D(dextrose)5W Isotonic: Supplies H2O, treats increased Na, 170 cal/L - D(dextrose)10W Hypertonic: Supplies H2O, 340 cal/L - 0.9 % NaCl Isotonic (nm saline): Expands intravascular fluid volume, replaces ECF losses. - 0.45 % NaCl hypotonic (1/2 nm saline): Replaces fluid volume for pt with increased Na. - 3-5 % NaCl (3-5 %nm saline) hypertonic: Treats symptomatic decrease in Na. - Ringer's (lactated) Isotonic: Expand intravascular fluid volume, replaces ECF losses.

Question 32

Complications of IV therapy: Infiltration

Answer 32

- Fluid leaks into interstitial space - S & S: + Coldness + Pain + Pallor + Swelling around infusion site

Question 33

Actions to correct complications of IV therapy

Answer 33

- Assess IV site q/h - Stop infusion and restart at a different site - Limit movement of extremity with IV.

Question 34

Stages of one IV infiltration

Answer 34

Painful IV site, no erythema, no swelling

Question 35

Stages of two IV infiltration

Answer 35

Pain, slight swelling, no blanching of finger, good pulse and brisk cap refill

Question 36

Stages of three IV infiltration

Answer 36

Pain, marked swelling, blanching, skin cool to touch, good pulse, and brisk cap refill

Question 37

Stages of four IV infiltration

Answer 37

Pain, very noticeable swelling, blanching, skin cool to touch, decrease or absent of pulse, cap refill more than 4 seconds, skin breakdown or necrosis

Question 38

Complications of IV therapy: Extravasation (what is it? S & S, and action)

Answer 38

What is it? - Infiltration of chemotherapy or other harmful drug into tissues around IV site. S & S: - Pain - Edema - Blistering - Tissue destruction - Infection - Loss of function in extremity Nursing Action: - Stop infusion - Treat symptoms and alert physician of any changes

Question 39

Complications of IV therapy: Phlebitis (what is it? S & S, and action)

Answer 39

What is it? - Irritation and inflammation of vein - Formation of clots = thrombophlebitis S & S: - Discomfort - Edema - Erythema - Warmth Nursing Action: - Stop infusion - Apply warm, moist compress - Start IV in another site

Question 40

Complications of IV therapy: Infection (what is it? S & S, and action)

Answer 40

What is it? - Introduction of microorganisms S & S: - Pain - Edema - Erythema - Warmth - Fever Nursing Action: - Surgical asepsis when inserting and caring for IVs - Assess q1h

Question 41

Complications of IV therapy: Fluid overload (what is it? S & S, and action)

Answer 41

What is it? - Rapid administration of IV fluids - Those who are most vulnerable include: babies, elderly, cardiac or renal disease. S & S: - Increase BP - Resp. distress - Crackles over lung fields - Edema - Weight gain Nursing Action: - Stop infusion rate - Monitor VS - Notify physician

Question 42

Electrolyte imbalance assessments

Answer 42

- Review physician's orders - Check order for solution, volume, flow rate, duration of therapy - Asses lab values, allergies, other health conditions, behaviour, LOC, pt knowledge. - Skin turgor, dependent edema, oral mucosa - Assess IV insertion site

Question 43

Process to hook up an IV

Answer 43

- Gather supplies - Prime and label line - Flush saline lock - Regulate flow rate - Regulate flow rate by gravity gtts/min = (mL/hr x drop factor)/(time in mins) - Regulate flow rate by pump

Question 44

Removing IV

Answer 44

- Check physician's orders - Assess IV site and note whether pt is on any anticoagulants - Remove tape and dressing - Stabilize catheter - Remove catheter, ensuring there's a tip. - Place gauze over site - Apply bandage and gauze with tape