NUR105 Fluid Balance - Module 1

Intracellular Fluid (ICF)

• fluid within the cells that provides the medium for cellular metabolism to occur

• 2/3 of the body’s water

Extracellular fluid (ECF)

• fluid that surrounds the cell and moves in and out of the cell

• divided into intravascular and interstitial

Intravascular fluid

• located in blood vessels

• sufficient volume is required to exert enough pressure to move the fluid from the blood vessels to the cells

interstitial fluid

• surrounds the cells and the blood vessels

• moves nutrients in and wastes out of the cell

• Makes up about 75% of ECF

Organs involved with fluid regulation

kidneys, hypothalamus and pituitary gland, Adrenal gland, heart, lungs, and GI system

Antidiuretic hormone (ADH)

• produced by the hypothalamus and secreted by the pituitary gland

• depends on plasma osmolality

  • increased osmolality = increase ADH = increased fluid retention

  • decreased osmolality = decreased ADH = increased fluid excretion

Aldosterone

• secreted by the adrenal cortex

  • in response to hyponatremia or hyperkalemia

insensible loss

the loss of fluid to the atmosphere with normal breathing

fluid intake

Fluid output is generally equal to what ?

Fluid Balance Assessment

Assessing: sensation of thirst, oral cavity, skin turgor, presence of edema, vital signs, weight, urine volume and color, and breath sounds

Fluid (volume) overload

-tachypnea, bounding tachycardia, rales/crackles, edema, hypertension, urine osmolality < 1.030, increased weight

Fluid (volume) Depleted

-tachycardia, orthostatic hypotension, urine osmolality > 1.030, dark urine, poor skin turgor, dry mucous membranes, thirsty

Colloid

solution with large particles, typically proteins, suspended in the solution

Crystalloid

• electrolytes are dissolved in a solution and then diffuse into the cells once administered

• isotonic, hypotonic, hypertonic

Isotonic solutions

• remain inside blood vessels

• some osmolality as body fluids

• 0.9% NaCl or Lactated Ringers

• given for: hypotension & hypovolemia

• Considerations: those at risk for fluid retention will hold onto this; replaces electrolytes

Hypotonic fluids

• draws fluid out of the intravascular compartment into the interstitial fluid compartment

• D5W, 1/2NS (0.45% NaCl), 0.33% NaCl, 0.2% NaCl

• given for: hyperglycemic conditions such as ketoacidosis; Expand the intracellular space

• dilute the extracellular fluid and rehydrate cells of clients who have hypertonic fluid imbalances

• considerations: can worsen cerebral edema, metabolism of dextrose makes the fluid hypotonic once absorbed, replaces fluid but does not affect sodium or potassium levels or osmotic pressure

Hypertonic fluids

• pulls fluid and electrolytes from ICF compartments into intravascular compartments

• D5NS, D5 1/2NS, D5 Lactated Ringers, 3% NaCl, 5% NaCl, D10W, D20W

• given for: blood pressure stabilization, increased UOP, reduce edema (some solutions only used in critical situations); severe hyponatremia

• Considerations: for severe hyponatremia; rarely used, used as a base for parenteral nutrition

Phlebitis

• complication of IV fluid therapy

• inflammation that occurs at the insertion site and along the vein of the IV catheter

• redness, warmth, pain, and firmness

• If noted = remove catheter and monitor site; apply a warm moist compress, start a different IV in a different limb if available

Sepsis

• complication of IV fluid therapy

• monitor for fever, redness, warmth, pain, and systemic signs of fever

Speed Shock

• seen after an extremely rapid administration of fluids

• tachycardia, pounding headache, dyspnea

notify provider, treat symptoms with a decrease in infusion rate, consider diuretics, and document

what do you do if you notice complications while administering IV fluids?

Midline Catheter

• 3-8 inches long

• single or dual lumen

• Clients who benefit:

  • limited peripheral veins

  • longer term IV antibiotics

  • heparin infusion for DVTs

  • repeated steroid infusions

• DO NOT

  • parenteral nutrition

  • any solution with an osmolality > 600

  • routine blood draws

  • incompatible med admin via dual lumen catheters

micro gtt

60 gtt/mL

macro gtt

10-15 gtt/mL

(volume mL x gtt factor) / time in min = IV flow rate gtt/min

drip calculation

72-96 hours

How often should a peripheral IV be replaced?

Infiltration

• leakage of IV solution or meds into the extravascular tissue

• edema, pallor, cool skin, and pain

• discontinue the IV line and elevate the extremity; possibly a warm compress

Extravasation

• IV medications are leaked into the tissue

• pain, stinging, burning, swelling, or redness at the site

• can cause severe tissue damage

• discontinue the line, apply a cool compress, request the antidote for the medication if available