Fluid Balance and TPN extra notes

how much fluid is lost through urine in adults

1200mL

how much fluid is lost through stool in adults

100-200ml - not very much because large intestine absorbs most of the fluid

how much fluid is lost through respiraiton

400ml - so increased resp rate can cause an increased loss of fluid

basic fluid requirements for maintenance

35ml/kg/day

what happens to fluid requirements during trauma or disease

the requirements go up to make up for excessive losses or down in times of fluid overload 

major determinant of osmolaity

sodium

general rule about hypertonic fluids

fluids high in sodium and/or glucose and hypertonic

when would we not want to give fluids

to patients in fluid excess (ex. bounding pulses, high BP, edema) - these patients will usually be on oral fluid restriction

common times where patients are NPO

acute severe illness and unable to eat, awaiting surgery, ventilated patients

what happens when patients are on NPO for more than 5 days

TPN - total parenteral nutrition needs to be given along with lipids

best maintenance choice fluid in peds

D5.45 NS

when would we give hypotonic fluid

for tx of diabetic ketoacidosis, hypernatremia - this will shift the fluid out of vasculature intocells

when would we want to give hypertonic fluids

for tx of cerebral edema, severe hyponatremia - it will shift fluid from cells into vasculature

1st choice resus fluid

NS or LR bolus - 500ml bolus and more PRN after assessment

colloids - aka plasma expanders - will increase BP rapidly and avoid peripheral edema - monitor for fluid overload!

what is the main tx for dehydrated patients

regular isontonic fluids like NS and LR - check Na levels in BW

for a patient with hyperglycemia would we give D5 fluids

NOOO just NS or LR because they already have too much glucose in their blood 

what does TPN stand for

total parenteral nutrition

TPN definition

IV admin of nutrients via a central venous catheter with GI tract cannot be used

PPN

short term/partial nutrition support - giving nutritional support through the vein for a short period of time

purpose of TPN

to provide complete nutritional support 

when would we want to use TPN

for patients with severe GI disorders, hyperemesis gravidarum (can’t keep anything down during pregnancy), severe malnutrition, pediatric clients, post op or critical care patients

composition of TPN - macronutrients

• Carbohydrates: dextrose (energy source)

• Proteins: amino acids 

• Lipids: essential fatty acids, they have more cals

protein fx

tissue repair, growing and wound healing

composition of TPN - micronutrients

• electrolytes: Na+, K+, Ca2+, Mg2+ phosphate

• vitamins: support metabolism

• Vitamin K - weekly SC or IM

where is vitamin k originally produced

in the gut flora in large intestine

fluids in TPN fx

for hydration and balance

complications of TPN

• infection (from central line, use aseptic technique)

• fluid overload (monitor I&O, daily weights)

• metabolic imbalances (ex. hyper/hypoglycemia, electrolyte shifts)

• Mechanical (ex. pneumothorax, hemothorax, air embolism)

which patients have fluid overload more

patients with heart and kidneys disease

nursing responsibilities

• verify TPN prescription and solution

• use an infusion pump for accuracy 

• monitor vitals, blood glucose, I&O and weights 

• maintain sterile technique when dealing with central line to prevent infection

• Report infection or imbalance promptly