Fluids & IV Therapy

Flashcards covering key terms and concepts related to fluids and intravenous therapy.

Homeostasis

The maintenance of a stable internal environment in the body despite changes in external conditions.

Intracellular Fluid (ICF)

Fluid found inside cells.

Extracellular Fluid (ECF)

Fluid located outside of cells.

Edema

Swelling caused by excess fluid in the interstitial space.

What are the 4 caused of edema?

Shifts of plasma to interstitial fluid, elevation of venous hydrostatic pressure, decrease in plasma oncotic pressure and elevation of interstitial oncotic pressure.

Fluid loss or gain calcuation

One liter of water weight 2.2 pounds, the body weight change is an excellent accurate indicator of overall fluid volume gain or loss.

Hypovolemia

A state of decreased blood volume, often due to loss of body fluids.

What are the clinical manifestations of hypovolemia?

• Restlessness, lethargy, confusion, thirst, dry mucous membranes, cold clammy skin.

• Decreased skin turgor, capillary refill decreased

• OH, increase HR & respirations

• Seizures and weight loss

Hypervolemia

Excess fluid in the body, abnormal retention of the fluid or interstitial plasma shifts. Can be related to heart failure, renal failure, long term steriod uses and polydipsia.

What are the clinical manifestations of hypervolemia?

Weight gain, edema, distention of neck veins, crackles, liver enlargement, headache, confusion, hypertension, polyuria, dyspnea, seizures.

Diuretics

Medications that promote the elimination of water and electrolytes via urine. These are used to treat hypervolemia.

Normal Saline (NSS)

An isotonic solution of sodium chloride used for fluid replacement.

What is the normal range of sodium?

136-145 mEq/L

What does sodium do for the body?

Helps control the fluid balance, helps with nerve signals & muscle contraction and is maintain by the kidneys.

Hyponatremia

A condition characterized by low sodium levels in the blood, and is caused by vominting diarrhea, NG suction and diuretics.

What are the clinical manifestations of hypoatremia?

Cells Swell, causing confusion, nausea, seizure and comas, can also dizziness, cold skin and low BP (when volume is low) and weight gain, edema, high BP and cramps (when volume is high)

Hypernatremia

A condition characterized by high sodium levels in the blood, which can be caused by not enough water (fever, diarrhea, sweating or dehydration) and to much sodium (hypertonic IVs, tube feeds w/o water)

What are the clinical manifestations of hypernatremia?

Thirst, dry mouth, confusion, restlessness, seizures, coma. If the fluid volume is high you will see swelling and high BP, but if the fluid is low you will see low BP, weakness and weight loss.

Potassium (K⁺)

An essential electrolyte for muscle and nerve function, heart rhythm control ad cell grow, normal range is 3.5–5.0 mEq/L.

Hyperkalemia

This is when there is an increase in potassium from either to much potassium intake (IV or PO), Potassium shifting out of cells, renal failure or certain medication’s.

Hyperkalemia clinical manifestations

Dysrhythmias, muscle cramps, weakness, fatigue, confusion, cramping/diarrhea, irregular/weak pulse.

What is Hypokalmia?

This is when there is a loss of K from vomiting, diarrhea, NG suction, diuretic or dialysis. There can also be shift in the cells form insulin, or stress and not enough intake of K

What are the clinical manifestations of hypokalmeia?

Dysrhythmias, a weak pulse, fatigue, cramps, decreased GI motility, constipation, shallow respiration, decreased reflexes, hyperglycemia.

Calcium (Ca²⁺)

Vital for bone health, blood clotting, nerve signals and muscle function, normal range is 9.0–10.5 mEq/L. This is regulated by the parathyroid hormone which increases the calcium and calcitonin with decreased the calcium.

Hypercalcemia

This is caused by hyperparapthroidism, cancer, prolonged immobilization, too much calcium/vitamin D, thiazides diuretics, acidosis.

Hypercalcemia clinical manifestations

Dysrhythmias (high BP,) fatigue, low reflexs, bone pain and fractures, kidney stones, dehydration, seizures and coma

Hypocalcemia

This is caused by Hypoparathriodism, kidney failure, pancreatitis, vitamin D deficiency, malnutrition, diarrhea, loop diuretics, low albumin or high phosphate levels.

Hypocalcemia clinical manifestations

Dysrhythmias, hypotension, tingling/numbness, especially around mouth, muscle cramps, chvoseks sign (face twitch), tetany, seizures, confusion, difficulty breathing.

Phosphate (Phos⁻)

An essential anion for cellular function, normal range is 3.0–4.5 mEq/L. This is needed for muscle function (especially the heart) RBCs, Nervous system, making ATP and glucose.nutrient metabolism. (controlled by parathyroid hormone). Relationship with calcium

Hyperphosphatemia

This is caused by renal failure, fleet enemas, excess phosphate laxatives, rhabdomyolysis, hypoparathyroidism and vitamin D toxicity.

Hyperphosphatemia clinical manifestations

Often has no symptoms, but does show the symptoms of hyocalcemia

Hypophosphatemia

This is caused by malabsorption, chronic diarrhea, Vitamin D deficiency, alcoholism, parenteral nutrition, phosphate-binding antacids, diabetic ketoacidosis, respiratory alkalosis, and hyperparathyroidism.

Hypophosphatemia clinical manifestations

Confusion, coma, weak muscles, seizures, heart failure, osteomalacia, rickets, muscle breakdown (rhabdomyolysis)

Magnesium (Mg²⁺)

An electrolyte important for ATP production, DNA/Protein synthesis, control blood glucose & BP, normal heart rhythm and stored in the bone. Normal range is 1.3–2.1 mEq/L.

Hypermagnesmia Causes

Renal failure (main cause), IV magnesium, tumor lysis.

Hypermagnesemia clinical manifestations

Lethargy, muscle weakness, urinary retention, nausea, vomiting, decreased reflexes, bradycardia, flushes warm skin.

Hypomagnesmia Causes

GI loss (diarrhea/suction), chronic alcohol use, malnutrition poor absorption, pancreatitis, excess urination, hyperglycemia, PPIs

Hypomagnesemia clinical manifestations

Confusion, vertigo, muscle cramps, tremors, seizures, hyperactive reflexes, chvostel & trousseaus sign, dysthymias, mimics hypocalcemia symptoms.

Chloride (Cl⁻)

A major negative ion that helps maintain fluid balance, normal range is 96–106 mEq/L.This works closely with sodium to regulate fliud balance, osmotic pressure and acid-base balance.

Hyperchloremia causes

Dehydration, to much saline, kidney disease, and metabolic acidosis.

Hyperchloremia clinical manifestations

Deep rapid breathing, weakness, fatigue, headache, High BP.

Hypochloremia causes

Vomiting, NG suction, excess sweating, diuretics, low sodium/potassium, burns or metabolic alkalosis.

Hypochloremia clinical manifestations

Muscle twitching, weakness, shallow breathing, irritability confusion, seizures.

Infusion Pump

A device used to deliver fluids, medications, or nutrients in a controlled manner.

Venipuncture

A medical procedure used to access a vein for blood withdrawal or therapy administration.

Isotonic Solution

A solution with the same salt concentration as the blood, preventing cell swell or shrink. Examples if normal saline solutions and lactated ringers.

Hypotonic Solution

A solution with a lower concentration of salt than the cells, causing them to swell. Examples include 0.45 sodium chloride

Hypertonic Solution

A solution with a higher concentration of salt than the cells, causing them to shrink. Examples include 5%

Blood Transfusion

A medical procedure involving the transfer of blood or blood components into a patient's circulation.

What are the requirements before a blood transfusion is given?

• Verify that order for transfusion

• Conduct assessment (VS)

• Informed consent obtained by physician

What are the expected reactions during a transfusion?

Chills, SOB, fever and itching.

What is the appropriate and patent vascular access?

#18 gauge IV or larger

What can be transfused with Blood and How long must it be infused for?

ONLY normal saline and even then it is normally only used to flus the line. It can be infused over 1-2 hours in severe cases but someone MUST be with the patient for the 1st 15 minutes.