1111 Fluid Imbalances Student View
Page 1
Introduction to Osmosis: Learning about fluid imbalances.
Author: Mary Katherine Carrano, BSN, RN.
Page 2: Water Balance of the Adult Body
Supply
Food: 800 ml
Drinks: 1500 ml
Losses
Skin: 350 ml
Breathing: 150 ml
Sweat: 450 ml
Metabolism: 300 ml
Fecal Matter: 150 ml
Urine: 1500 ml
Total: 2600 ml
Net water balance needs to equal out at 2600 ml.
Page 3: Body Fluid Compartments
Overview of compartments in which body fluids are distributed.
Page 4: Laboratory Tests
Common tests related to fluid balance:
CMP (Comprehensive Metabolic Panel)
BMP (Basic Metabolic Panel)
BNP (B-type Natriuretic Peptide)
CBC (Complete Blood Count)
Albumin levels- important for maintaining oncotic pressure and fluid balance in the body.
Serum osmolality- a measure of the concentration of solutes in the serum, which plays a crucial role in assessing hydration status and the body's fluid balance.
Urine specific gravity: 1.005 - 1.030- 1.030 - indicates concentrated urine, suggesting potential dehydration or fluid imbalance.
BUN (Blood Urea Nitrogen) / CR (Creatinine)- indicators of kidney function and hydration status, as elevated levels can suggest dehydration or impaired renal function.
Page 5: Homeostasis
Definition: Keeping everything in balance.
pH
Importance of pH balance in bodily functions.
Page 6: Homeostatic Mechanisms
Elements of Water Homeostasis
Thirst response: triggers when body water is low.
Antidiuretic Hormone (ADH): regulates water retention.
Osmosis: movement of water through semipermeable membranes.
Page 7: Three Fluid Imbalances Threatening Homeostasis
Dehydration- a state where the body loses more fluids than it takes in, leading to a decrease in blood volume and potential disruption of cellular function.
Hypovolemia- a condition characterized by a decreased volume of blood circulating in the body, which can result from excessive fluid loss, inadequate fluid intake, or both, and can lead to symptoms such as low blood pressure, rapid heart rate, and shock.
Hypervolemia- an excess of fluid in the body, often resulting in increased blood volume, which can lead to symptoms such as swelling, high blood pressure, and strain on the heart.
Page 8: Dehydration
Definition
Loss of water or insufficient intake without sodium loss.
Causes:
Diarrhea
Vomiting
Excessive sweating
Increased urination (due to medications)
Illnesses (e.g., diabetic ketoacidosis)
Fever
Insufficient intake
Page 9: Symptoms of Dehydration
Thirst: onset occurs after ~2% body weight loss.
Fatigue: critical symptom affecting concentration and reaction time.
Other Symptoms:
Dry mouth, dark urine, confusion, dry skin, muscle cramps, poor concentration, irritability, decreased urination, headaches, nausea, sleep impairment, fainting.
Dehydration Manifestations:
Moderate: altered cognitive function, thirst, lethargy, dry mucosa, oliguria.
Severe: tachycardia, hypotension, shock, coma, death.
Labs for Diagnosis:
BMP, CMP, BUN, serum osmolality, urine specific gravity.
Treatment:
Restore water balance: Oral or IV D5W solutions.
Page 10: Dehydration Nursing Care
Monitor respiratory rate and oxygen levels.
Monitor laboratory results.
Measure weight.
Observe for nausea/vomiting and treat accordingly.
Monitor neuro status and ensure safety.
Assess heart rate and rhythm.
Ensure IV access and provide appropriate fluids.
Page 11: Fluid Imbalances - Hypovolemia
Definition
Loss of both fluid and electrolytes.
Causes:
Blood loss, gastrointestinal losses, severe burns, third spacing, fever, diuretics, trauma.
Page 12: Hypovolemia Manifestations
Early Signs:
Thirst, dry mucous membranes, decreased skin turgor, decreased urine output, and capillary refill.
Moderate Signs:
Lethargy, muscle weakness, orthostatic hypotension.
Severe Signs:
Tachycardia, hypotension, confusion, tachypnea, chest pain, oliguria, hypovolemic shock.
Labs:
BMP, CMP, BUN/CR, CBC, urine specific gravity.
Treatment:
Identify cause and replace fluids.
Administer normal saline or Lactated Ringer's IV; consider PRBCs or platelets.
Page 13: Fluid Imbalances - Hypervolemia
Definition
Condition with excess water and sodium in extracellular spaces.
Causes:
Heart failure, kidney failure, nephrotic syndrome, cirrhosis, pregnancy, certain medications, excessive sodium intake.
Page 14: Hypervolemia Manifestations
Signs and Symptoms:
Tachycardia, jugular vein distention, hypertension, bounding pulse, dyspnea, crackles in lungs, cough, pallor, peripheral edema (may be pitting).
Labs:
Conduct physical exams, BMP, CMP, BNP, HCT weight, I/O, urine specific gravity.
Treatment:
Identify cause, rid body of excess fluids.
Administer diuretics, implement fluid restrictions, and perform daily weights or dialysis if necessary.
Page 15: Hypervolemia Nursing Care
Monitor breath sounds and respiratory function.
Observe for dyspnea and assess ABGs.
Use chest X-ray (CXR) as needed.
Provide supportive positioning and monitor edema.
Implement fluid restrictions and administer diuretics as necessary.
Page 16: Age-related Considerations
Special considerations for older adults and infants regarding fluid balance and rehydration strategies.
Page 17: Rehydration
Overview of methods and importance of rehydration in clinical practice.
Page 18: IV Fluid Therapy
Definition
Intravenous therapy for rehydration when oral intake is insufficient or contraindicated.
Prescribed by a healthcare provider.
Page 19: IV Therapy Responsibilities
Nurses are responsible for initiating, caring for, and managing vascular access devices.
Key Responsibilities:
Monitor IV sites, assess tubing, solutions, rate of administration, and observe patient reactions (labs, skin integrity, intake/output).
Page 20: Types of IVs
Peripheral IV Catheters
Midline Catheter
Central Venous Access Devices
Centrally inserted devices
Peripherally Inserted Central Catheters (PICC)
Implanted Infusion Ports
Additional Types:
Non-Tunneled Central Venous Catheter
Tunneled Central Venous Catheter
Page 21: Establishing Peripheral IV Access
Steps and considerations for establishing peripheral IV access including preparation and safety measures.
Page 22: IV Care
Responsibilities of Registered Nurse
Palpate IV area to assess for complications.
Maintain patency of IV line and change dressings.
Follow protocols for discontinuing IV and safety measures.
Page 23: IV Complications
Infiltration: Leakage of IV fluid into surrounding tissue, causing swelling and discomfort.
symptoms- swelling at the site, pain or tenderness, and coolness of the skin surrounding the IV site.
Phlebitis: Inflammation of the vein, often presenting with redness and tenderness at the site.
symptoms- redness along the vein, warmth, and possible formation of a cord-like structure.
Infection: Signs include fever, drainage, and increased pain at the IV site.
symptoms- swelling, hardness, and the presence of pus or other discharge.
Air embolism: Rare but serious, characterized by sudden respiratory distress and altered mental status.
symptoms- dizziness, chest pain, and a rapid heart rate that may indicate a significant disruption in blood flow.
Extravasation: Leakage of IV fluid containing irritants or vesicants into surrounding tissue, leading to severe damage and potential necrosis.
symptoms- swelling, redness, and pain at the site of infiltration, which can progress to blistering and tissue breakdown if not addressed promptly.
Hematoma- A localized collection of blood outside of blood vessels, typically resulting from trauma, which can cause swelling and pain at the site.
symptoms- bruising, tenderness, and warmth in the affected area, which may also lead to restricted movement depending on the location and severity of the hematoma.
Infection
Occurs from microorganisms invading the IV line.
Symptoms:
Local pain, warmth, edema, induration, malodorous drainage.
Systemic: Fever, chills, malaise, elevated WBC count.
Phlebitis
Inflammation of vein from improper administration or cannula size.
Symptoms:
Erythema, edema, warmth, pain, red streak along vein.
Infiltration
Leakage of IV fluids into surrounding tissues.
Symptoms:
Swelling, damp site, cold to touch, pain, slow rate of infusion.
Extravasation
Leakage of vesicant agents into tissues, causing damage.
Symptoms:
Pain, edema, burning, erythema, blisters.
Hematoma
Occurs from improper catheter removal.
Symptoms:
Swelling, pain, ecchymosis.
Air Embolism
Fatal condition from air entering the venous system.
Symptoms:
Hypotension, tachycardia, difficulty breathing, cyanosis.
Page 24: Peripheral IV & Catheter Types
Details and diagrams of central venous catheters, midline catheters, and PICC lines.
Page 25: Catheter Types Overview
Overview of non-tunneled and tunneled central venous catheters, including illustrations and placement techniques.
Page 26: Comparison of Line Types
Central lines vs. PICC lines vs. midline lines: Differences in insertion and usage.
Page 27: Key Points When Removing Central Line
Intervention and Rationale
Position patient supine to minimize air embolism risk.
Cut sutures to reduce risk during removal.
Ask patient to perform Valsalva maneuver to reduce air entry.
Visualize catheter tip to ensure integrity.
Apply sterile dressing to prevent air entry and maintain site integrity.
Page 28: Catheter Features
Description of catheter and medication administration through ports.
Page 29: IV Components
Overview of syringes, tubing, hubs, and the function of port access.
Page 30: IV Tubing Components
Breakdown of IV tubing features including spike cap, luer lock, and flow control clamps.
Page 31: Measuring Intake & Output
Methodology for calculating total IV fluid intake based on orders and monitoring.
Page 32: IV Fluid Solutions
Overview of various IV fluid categories and their purposes.
Page 33: Types of IV Solutions
Hypotonic Solutions
0.45% NS, 0.225% NS, 0.33% NS
Uses:
Treat cellular dehydration, contraindications with burns, liver disease.
Isotonic Solutions
0.9% NS, LR, D5W
Uses:
Treatment for blood loss, dehydration, vomiting, and metabolic acidosis.
Hypertonic Solutions
D10W, D5LR, D5NS, 3% NS, 5% NS
Uses:
Treatment of hyponatremia, edema management, and requires careful monitoring.