IVT 2

What are the purposes of fluid in the body?

Lubricates joints

Absorbs shock for internal organs

Transports nutrients and waste

Serves as a medium for metabolic waste

Regulates body temperature

What are the 3 fluid compartments in the body?

Interstitial fluid

intravascular fluid

intracellular fluid

what does osmotic pressure refer to in fluid?

The force created when two solutions of different concentrations are separated by a selectively permeable membrane.

What is the difference between hypotonic, isotonic, and hypertonic fluids?

Hypotonic fluids have lower tonicity than body fluid

isotonic fluids have the same tonicity

hypertonic fluids have higher tonicity than body fluid

what is the nursing consideration for 0.9 percent normal saline

isotonic

replaces losses without altering fluids

should not be used in patients with heart failure, edema, or hypernatremia

What are the signs of Fluid Volume Excess (FVE)

edema

tachycardia

htn

crackes in lungs

distended neck veins (jvd)

What is the normal sodium level range

136-145 meg/L

Signs of Hypokalemia

muscle weakness, cramps, dysrhythmias, weak pulse, n/v

What does trousseau’s sign indicate

Hypocalcemia

Key differences between tpn and ppn

tpn- hypertonic and used for total nutritional needs through a central line

ppn - has lower concentration and can be infused through a peripheral IV

Local complications of IV therapy

infiltration

extravasation

thrombophlebitis

phlebitis

hematoma

signs of septicemia/sepsis

tachycardia

fever

chills

low bp

increase in wbc count

precautions for infusion pumps

prevent fluid overload and maintain IV patency, while also allowing specific medication/volume administration

contraindications for .45% NS

brain injuries

increased ICP

cardiovascular collapse

indications for .45% NS

hypernatremia

hyperglycemia

what kind of solution is .45% NS

Hypotonic

indications for D5W

IV pain meds

hypernatremia

contraindications for D5W

hyperglycemia

hyponatremia

brain swelling

solution is D5W

Hypertonic, but hypotonic after metabolized in blood

indications for .9% NS

dehydration

fluid replacement without altering fluid concentrations

Indications for LR

-Loss of Fluid and electrolytes-

burns

diarrhea

during surgery

Contraindications for LR

Renal disease

(hyperkalemia)

liver disease (lactic acidosis)

Electrolytes found in LR

Na

K

Ca

Cl

Lactate

What kind of fluid is LR

Isotonic`

indications for D5NS

Replacement of Calories Na Cl

contraindications for D5NS

Heart failure, hypernatremia, renal failure (fluid overload in ECF)

D5NS fluid type

Hypertonic

Indications for D5LR

decreased calorie intake due to vomiting

diahrrea not eating

Contraindications for D5LR

hyperglycemia

D5LR fluid type

Hypertonic

Nursing interventions for FVE

vitals, Qd weights, I+Os diuretics per DR, fluid restriction

interventions for FVD

I+O’s fluid replacement IV QD weights

S/S of FVD

Dry mucous membranes

HTN

skin turgor

increased HR and RR

Non-vented tubing

IV bags

Vented Tubing

Glass tubing

volume control chamber

Used in pediatrics to precisely control amount

What are infusion pumps primarily used for

maintain patency of Iv’s

administers a specific amount of meds/fluids

prevent fluid overload

Peripheral access types

peripheral IV, midline catheter

central access types

CVC Picc

where does the catheter tip lie in a central line?

Superior vena cava, right atrium

PICC Line

Basilic or Cephalic vein

Long term use

sterile technique when changing dressoing

CVC Line

Jugular or subclavian vein

Tunneled CVC

Long term use

tunneled through subcutaneous tissue before existing skin protects against infection

Non tunneled CVC

High infection risk

short term use

emergency use (Rapid blood infusion)

Central line dressing procedure

sterile technique

1st change in 24hr, then qwk or per policy

Parental nutrition indications

used when PT unable to meet nutritional needs PO or tube feed

pancreatitis

complete bowel rest

bowel obstruction

Total Parental Nutrition

hypoertonic sol. (dextrose) contains proteins, fats, carbs

infused by central line only

PPN

Same as TPN but lower concentration

can be infused peripherally

Hyponatremia causes

Diuretics

diarrhea

increased water

S/S hyponatremia

lethargy

n/v

cramping

Causes of hypernatremia

increased sodium intake

lower water intake

fever

s/s hypernatremia

hallucinations

siezures

dry mucuous membrane

Potassium normal range

3.5-5

hypokalemia causes

gi suction

potassium wasting dieuretics

diarrhea

low intake

s/s hypokalemia

dysrhthmias

n/v

irregular/weak pulse

interventions for hypokalemia

ecg

vs

potassium iv or po

10meq/l

causes for hyperkalemia

renal failure

trauma

burns

potassium sparing diuretics

s/s hyperkalemia

dysrhythmias

muscle weakness

abd. cramping

interventions for hyperkalemia

ecg

kayexalate

insulin + dextrose

normal calcium range

9-10.5

Hypocalcemia causes

Vit d deficiency

hypoparathyroid

alcoholism

s/s hypocalcemia

numbess/tingling fingers and face

dysrythmias

positive chvostek and trousseau sign

interventions hypocalcemia

ca iv or po

hypercalcemia causes

Bone cancer

prolonged BR

s/s hypercalcemia

decreased muscle tone

lethargy

constipation

dysrhyhtmias

nursing interventions hypercalcemia

AROM

ECG

increase fluid

Magnesium normal range

1.3-2.1

causes hypermagnesemia

increased antacids

prolonged Iv mag sulfate

s/s hypermagnesemia

warm+flushed

lethargy

hypotension

shallow rr

respiratory arrest

interventions hypermagnesemia

vs

ecg

loop diuretics

calgluc if iv overdose

causes of hypomagnesemia

low intake

ng suction

diuresis

diarrheas/s

s/s hypomagnesemia

irritable muscle/nerves

hyperactive dtr

dysrythmias

seizure

nursing interventions hypomagnesemia

ecg

siezure precaution

mag supplements po or iv