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.