Fluid and Electrolights

Fluid =

Water that contains dissolved and suspended such as glucose, mineral salts, and proteins

Fluid amount=

Volume

Fluid concentration=

Osmolality

degree of acidity =

pH

Intracellular-fluid inside the cells

2/3 of body water

• plasma, trancellular fluids such as CSF, pleural,peritoneal, and synovial fluid

Extracellular fluid outside the cell

• interstitial fluid b/w the cells

• intravascular fluids inside vessels

• Transcellular

Positive cations

• Na+

• K+

• Ca 2+

• Mg2+

Negative Anions

• Cl-

• HCO3-

Concentration

• fluid containing of dissolved particles is more concentrated the same amount of fluid contains few particles

Osmolality

• measure of the number of particles per Kilogram of water

• some particles pass easily through cell membranes; others such as Na+ cannon cross easily

Tonicity

cannot cross cell

Isoronic-

Same tonicity

hypotonic:

Fluid more Dilute than blood

Hypertonic

fluid more concentrated than more blood

Filtration

Fluid moves into and out of capillaries

Active transport

Uses ATP to move electrolytes across cell membrane against concentration gradient (low to high concentration)

Diffusion

Passive movement of electrolytes or other particles down a concentration gradient (high to low concentration)

Osmosis

water moves through membrane separates fluid with different particle concentrations

Osmotic pressure

inward-pulling force by particles in fluid

Fluid intake

healthy adult 2300L

8-10 glasses per day 1920-2400 mL

80% food, 20% from food

fluid output

occurs in organs

• skin

• lungs

• GI

• kidneys

sensible loss

(visible) urine, feces, gastric drainage

insensible loss

(not visible) diffusion and evaporation through skin, lungs (water lossthrough skin/lungs)

Hypovolemia (ECV deficit)

output exceeds intake of sodium-containg fluid

• sudden weight loss

• postural hypotension

• tachy

• thready pulse +1

• dry mucous membrane

• poor skin turgor

• dark yellow urine

Hypervolemia (ECV excess)

intake of sodium-containg isotonic fluid has exceeded fluid output

• sudden weight gain

• edema

• DNV

• crackles on auscultation

HyperNAremia

“water deficit”; hypertonic across cell membranes

• serum Na+>145mEq/L (145mmol/L)

• DEHYDRATION

• Decrease LOC (confusion, lethargy, coma)

• Thirst, dry mucous membrane

• Seizures

HypoNatremia

“water excess”, hypotonic

• intracelluar dehydration

• Serum Na+ level <136mEq/L (136 mmol/L)

• decrease LOC (confusion, lethargy, coma)

• Seizures if develops rapidly or is very severe

A nurse is assessing a PT admitted w clinical dehydration. Which of the following findings would the nurse expected?

• Dry Mucous membrane

• Concentrated urine

• Hypotension

• confusion

HyperKalemia

potassium K 3,5-5.0 mEq/L

cause: Oliguria decrease K output , chronic Renal failure ESRD, DKA, use of potassium sparing diueretics

muscle weakness

Life Threatening Dysrhythmias

Cardiac Arrest

Foods: Fruits,potatoes,instant coffee,molasses Brazil nuts

HypoKalemia

cause: increase potassium output include diarrhea repeated vomiting, and use of potassium-wasting diuertics, glucosteroids therapy, Treatment for DKA

Muscle weakness

Resp muscle weakness

ECG-ST segment dep

Life Threating Dysrhythmias

Foods: Fruits,potatoes,instant coffee,molasses Brazil nuts

HyperCAlcemia

9.0-10.5 mg/dl

cause: increase calcium intake & absorption, shift of calcium and bone into the ECF, and decrease calcium output, some malignancies, prolonged

Food: diary products, canned fish w bones, broccoli ,oranges , requires vit D for best, absorption, undigested fat prevents absorption

HypoCAkcemia

cause: too much Ionized calcium to shift to the bound forms (pancreatitis) Chronic diarrhea, steatorrhea, laxative misuse

Food: diary products, canned fish w bones, broccoli ,oranges , requires vit D for best, absorption, undigested fat prevents absorption

HypoCAkcemia s/s

• neuromuscular exitability

• tetany

• chvostek’s and Trousseau’s sign

• muscle Twitching

• Hyperactive reflexes

hyperCAlcemia

s/s

• Anorexia, N/V

• pathological fractures

• decrease neuromuscular

• excitability

• decrease reflexes

• lethargy, confusion

• cardiac arrest if severe

HyperMAGnesemia

1.3-2.1 mEq/L

cause: ESRD, excessive use of magnesium contacting laxatives

Food: dark leafy vegetables, whole grains, undigestive fat prevents absorption

hypermagnesemia s/s

• decrease neuromuscular excitability

• lethargy

• decrease DTRs

• brady

• severe-carduac Arrest, decrease RR

HypoMAGnesemia

casues: decrease mag intake and absorption, sift of plasma mag to its inactive bound form, and increase mag output, Alcoholism , malnutrition, chronic Diarrhea

HypoMAGnesemia

s/s

• neuromuscular excitability

• chovostek’s sign

• hyperactive DTRs

• tetany

• cardiac dysrhythmias

acid production

• cardbonic acid-excreated by lungs

• metabolic acid-excrered by kidneys

Respiratory Acidosis

Alveolar Hypoventilation- the lung are unable to excrtet enough CO2

• paCO2 rises, creating an excess of cardbonic acid in blood , which decreases pH

respiratory alkalosis

Alveolar hyperventilation lungs excrete too much cardbonic acid

• paCO2 falls,creating a deficit of carbonic acid in the blood, which increases pH

Metabloic acidosis

• occurs from an increase of metabolic acid or a decrease of base (HCO-3)

Metabolic Alkalosis

occurw from a direct increase of base (HCO-3) or a decrease of metabloic acid increase blood HCO3- by release

<7.35 = pH

acidosis

>7.35 = pH

alkalosis

PaCO2 >45mm Hg =

respiratory Acidosis

_{PaCO2 <35 mmHg=}

respiratory alkalosis

HCO3 <21 mEq/L =

metabolic acidosis

Hco3 >28 mEq/L

metabolic alkalosis

Age: very young and old at risk

• Very young: ECV deficit, osmolality imbalances, clinical dehydration

• Very old: ECV excess or deficit, osmolality imbalances

Environment: excessively hot?, physical work, fluid replacements with salt?

• intake: fluids, salt, foods rich in potassium, calcium, and

  magnesium

• Lifestyle: alcohol intake history

• Medications: include over-the-counter (OTC) and herbal, in addition to

  prescription medication

Skin and Mucous membranes (Tugor), Vital Signs

• Daily weights

• Best indicator of fluid status

• Each kilogram (2.2 lb) of weight gained or lost overnight is equal to 1 L of

  fluid retained or lost.

• Weigh the patient at the same time each day with the same scale after a

  patient voids Use same conditions

examples of patients w fluid, electrolytes and acid-base altertions

• fluid imbalance

• Dehydration

• electrolyte imbalance

• acid base imbalance

• lack of knowledge of fluid regime

planning

goals and outcomes

setting priority's

teamwork and colab

implementation

• teach pt and caregivers to recognize risk factors for dev imbalances and implement appropriate preventive measure

• teach pt w chronic conditions about risk factors and sign of imalance, and to do if they occur

Fluid intake and output (I&O)

• 24-hour I&O: compare intake versus output

• Intake includes all liquids eaten, drunk, or received through feeding tubes, IV

• output = Urine, diarrhea, vomitus, gastric suction, wound drainage

Assessment

• lab values

• cbc

• electrolytes

• serum/urine osmolality

• UA

• ABG’s

Isotonic

• 0.9% saline (NRN)

• Lactated ringers (LR)

• 5% Dextrose in water

Hypotonic

• 0.45% saline (1/2 NS)

• 0.225% saline (1/4 NS)

• 0.33% saline (1/3 NS)

Hypertonic

• 3% saline

• 5% saline

• 10% Dextrose in water (D10 W)

• 5% Dextrose in 0.9%

• 5% dex in 0.45% saline

• 5% dex in lactated ringers

Inserting of the intravenous line

• Guage

• length of treatment

• type of fluid

• a peripheral VAD is called an over-the-needle cath; consists of a small plastic tube or cath threaded over a sharp stylet (needle)

• butterfly needle

IV adm

1. Infusion of large volumes of IV fluid containers

that contain medications mixed, labeled, and

dispensed by pharmacy

2. Injection of a bolus or small volume of medication

through an existing IV infusion line or intermittent

venous access (heparin or saline lock)

3. “Piggyback” infusion of a solution containing the

prescribed medication and a small volume of IV

fluid through an existing IV line

IV Bolus

Introduces a concentrated dose of medication

directly into the systemic circulation.

•  Advantageous when the amount of fluid that a patient can take is restricted.

• The most dangerous method for medication administration because there is no time to correct errors.

• Confirm placement of the IV line in a healthy site.

•  Determine the rate of administration by the amount of medication that can be given each minute.

volume controlled infusions

• small amounts (50-100mL) compatible fluids

• adm sets, piggy back stem, & syringe pumps

IVPB-IV piggy back

• small (25 to 250 mL) IV bag or bottle short line that connects to the upper Y-port of a primary line or to an intermittent venous access

regulating the infusion rate (IV pump)

Avoid uncontrolled flow into a patient, Use Electronic infusion devices (EIDs), IV pumps

• Calculate the flow rate (mL/hr) at prescribed time frame.

• Maintaining the system

• Keeping the system sterile and intact;

• Changing IV fluid containers, tubing, and contaminated site dressings;

• Helping a patient with self-care activities so as not to disrupt the system;

• Monitoring for complications of IV therapy.

Blood transfusion

Autologous transfusion (autotransfusion) is the collection and reinfusion of a patient’s own blood.

blood transfusion s/s

Anemia

• Blood loss

• Increasing circulating blood volume after surgery,trauma, or hemorrhag

• Deficiency in blood component

• Clotting factors, platelets, albumin

• Hemoglobulin < 7 or 8 with active bleed/symptomatic

Group A

Has only the A antigens on the red cells and (B antibody in the plasma)

Group B

Has only the B antigen on red cells (A antibody in plasma)

Group AB

Has both A & B antigens on red cells (neither A nor B antibody in plasma)

Group O

Has neither a Norby antigens on red cells, but (both A and B Antibodies are in the plasma)

Transfusion blood products

Two RNs verify

• Stay with patient for the first 15 minutes

• VS Q 15 times 2, then 30 min, then post-infection

Mild allergic allergy to blood

Flushing, itching, urticaria (hives)

Sepsis bacterial contamination of blood

Rapid onset of chills, high fever, severe hypotension, and circulatory

shock

May occur: Vomiting, diarrhea, sudden oliguria (acute kidney

injury), disseminated intravascular coagulation (DIC)

Febrile non-hemolytic sensitivity to white blood cells, plasma protein

Sudden shaking chills (rigors), fever (rise in temperature 0.5c 1F

Headache, flushing, anxiety, muscle pain

Hemolytic reaction right blood cell breakdown due to incompatible blood

Chills, fever, low back pain, flushing tacky tacky Peia hypotension hemoglobinuria sudden oliguria (acute kidney injury) circulatory, shock, cardiac arrest, and death

Circulatory overload too much or two rapid infusion

• Dyspnea, cough, crackles or rails lobes of lungs

• DNV went upright

Blood transfusion reactions

• Stop transfusion if suspected reaction

• Replaced with saline infusion

• Notify HCP

• IF HEMOLYTIC-send Tubing, blood, sample of blood and urine from PT to lab

• Prepare to call a code/ CPR/ MEDs

A nurse is assessing a patient with hyponatremia. Which of the following clinical manifestations should the nurse expect?

Confusion and seizures

A nurse is reviewing a patient’s lab results and notes a potassium level of 5.8 mEq/L. Which of the following interventions should the nurse anticipate?

Prepare the patient for sodium polystyrene sulfonate ( kayexalate) adm

A patient is admitted with severe dehydration. Which of the following findings should the nurse expect?

Hypotension

A nurse is caring for a patient with metabolic acidosis. Which of the following conditions is a potential cause of this imbalance?

Diabetic ketoacidosis

A nurse is monitoring a patient receiving IV magnesium sulfate for hypomagnesemia. Which of the following findings indicates magnesium toxicity?

Positive Trousseau’s sign

The nurse is assessing a patient with hypocalemia. Which of the following findings should the nurse expect

Distended neck veins

A patient with a history of heart failure is admitted with fluid volume overload. Which of the following findings should the nurse expect?

Respiratory depression

A nurse is reviewing a patient's arterial blood gas (ABG) results: pH 7.30, PaCO₂ 50 mmHg, HCO₃ 24 mEq/L. The nurse recognizes these findings indicate which acid-base imbalance?

Respiratory acidosis

A nurse is providing care for a patient with hypernatremia due to dehydration. Which of the following interventions should the nurse include in the plan of care?

Encourage oral fluids and adm hypotonic IV fluids

A patient with heart failure has a sodium level of 128 mEq/L. Which of the following factors may have contributed to this imbalance

Excessive Diuretic use

1. An IV fluid is infusing more slowly than ordered. The infusion pump is set correctly. Which factors could cause this slowing? (Select all that apply.)

1. Infiltration at VAD site

2. Patient lying on tubing

Tubing kinked in bedrails

The nurse assesses pain and redness at a VAD site. Which action is taken first?

Discontinue the IV infusion

When delegating I&O measurement to assistive personnel, the nurse instructs them to record what information for ice chips?

One-half of the volume

What assessments does a nurse make before hanging an IV fluid that contains potassium? (Select all that apply.)

Urine output

Serum potassium laboratory value in EHR

The health care provider’s order is 500 mL 0.9% NaCl intravenously over 4 hours. Which rate does the nurse program into the infusion pump?

125 mL/hr

Which of the following steps are necessary when inserting a short-peripheral IV? (Select all that apply.)

1. Apply tourniquet to arm 10 to 15 cm (4–6 inches) above theintended insertion site.

2. Cleanse skin using an approved antiseptic agent such as alcohol-based 2% chlorhexidine and allow to dry thoroughly.

4. Use the smallest-gauge, shortest catheter available and insert with the bevel up at a 10- to 15-degree angle.

5. Observe for blood in the flashback chamber of the catheter

and advance the catheter off the needle into the vein.

Place the following steps for discontinuing IV access in the correct order:

1. Carefully check the healthcare providers order

2. Used to identifiers to ensure correct patient

3. Explain procedure to patient

4. Perform hand hygiene and apply gloves

5. Stop the infusion and clamp the tubing

6. Remove IV site dressing in tape

7. Clean the site with withdraw the catheter and apply pressure

A patient has hypokalemia with stable cardiac function. What are the priority nursing interventions? (Select all that apply.)

Fall prevention intervention

Monitor for constipation

Which assessment does the nurse use as a clinical marker of vascular volume in a patient at high risk of ECV deficit?

Fullness of neck veins when supine