Fluids
What systems are fluid and electrolytes regulated by?
Renal, Cardiac, GI, Pulmonary, and pituitary systems
What is the definition of dehydration?
What are the different water conversions
When fluid intake and retention does not meet the bodies fluid needs and results in fluid volume deficit
1L of water = 2.2lbs
2.2lb=1kg
1lb= 500mL
This can occur in healthy people as a result of changes in fluid I's and O's and can be life threatening if severe.
Electrolyte imbalances
What are the normal ranges for magnesium and what are its functions in the body
Normal: 1.3 to 2.1 mg/dL
It is critical for
-skeletal muscle contraction
-carbohydrate metabolism
-ATP formation
-Vitamin activation
- Cell growth
What are IEDS
Electronic infusion devices also called Iv pumps or infusion devices that deliver accurate hourly iv infusion rate
They use positive pressure to deliver a measured amount of fluid during a specific unit of time
What is the average fluid intake and what are the different ways you can intake fluid?
8 glasses; 64oz; 2L; 2300mL
All liquids eaten (jello), drank, or received through IV
What are the 3 different types of hormonal regulations for fluid balance?
Aldosterone
Antidiuretic hormone
Natriuretic peptides
This electrolyte has a normal range from 98-106MEq/L
Imbalances for this electrolyte occur as a result of other electrolyte imbalances
Chloride
What is a buffer and what is ratio to maintain a buffer?
Buffers are pairs of chemicals that work together to maintain normal pH of body fluids
Must maintain a 20:1 ration of bicarb to carbonic acid for regulation
Steps of initiating IV therapy
2) Assess appropriateness of solution for the pt
3) Assess arms and hands for potential sits to start IV
-Maintain the system(keep sterile and intact)
4) Change iv fluids, tubing (every 72 hrs), and dressings
5) assess pt with self-care activities
What are the different body parts that aide in fluid output?
Kidneys, GI tract, Skin, and lungs
What different systems would you focus your assessment on when assessing for dehydration?
Cardiovascular
Respiratory
Skin
Neurologic
Renal
Normal ranges for this electrolyte are 3.0 to 4.5mg/dL
It is found in bones and has an inverse relationship with calcium
It activates vitamins and enzymes and assists in cell growth and metabolism
Phosphorus
What are the two systems that excrete acid?
Lungs: excrete carbonic acid ( when you exhale you excrete carbonic acid in the form of CO2 and water)
Kidneys: excrete metabolic acid (kidneys excrete all other metabolic acids except carbonic)
What are the S&S of infiltration and how do you treat it?
What are the other complications of IV therapy?
Swelling at Iv site, leaking of fluids or blood, and pain at site of insertion. Treat by removing IV immediately and applying a warm compact
Circulation overload
Phlebitis
Local/ systemic infections
Bleeding at venipuncture site
What are some abnormal ways fluid is outputted
Vomiting, wound drainage, and hemorrhage
What are the two major fluid compartments in the body and their subdivisions
What are the major cations in extracellular fluid
What are the major anions in intracellular fluid
Extracellular
-Makes up 1/3 of body fluid
-outside the cell
-2 compartment subdivisions (interstitial and inter-vascular)
Intercellular Fluid
-2/3 body fluid volume
-Inside the cell
Sodium is the major cation in extracellular and chloride is also there
Potassium is the major intracellular electrolyte
Normal ranges for this electrolyte is 9.0 to 10.5 mg/dL
Absorption of it requires active form of vitamin D
It is stored in bones
During imbalances it causes musculoskeletal disfunction
Calcium
This type of acid-base imbalance arises from alveolar hypoventilation. The lungs are unable to excrete enough CO2 and excess carbonic acid in the blood decreases the pH
Respiratory Acidosis
what are the two different types of vascular access devices?
Overall vascular access devices are catheters or infusion ports designed for repeated access to the vascular system
2 types
-Peripheral catheters: are for short-term use (fluid restoration after surgery and Antibiotic administration)
-Central catheters/ implant ports: are for long-term use and empty content at or near central veins (PICC lines and triple lumens)
*At are normally in the subclavian area and have a very high risk of infection
*TPN must be in a central line
What are the different forces that determine fluid movement and explain them
Osmosis: process of moving water from an area of low particle concentration to an area of higher particle concentration
Diffusion:Diffusion is passive movement of electrolytes or other particles down the concentration gradient (from areas of higher concentration to areas of lower concentration)
Filtration: mediated by fluid pressure from an area of higher pressure to an area of lower pressure
-Hydrostatic pressure: forces that push water outward from a confined space through a membrane (edema develops with changes in normal hydrostatic pressure differences)
What are the electrolyte and fluid imbalance considerations for older adults?
They are at risk for most electrolyte imbalances from age related organ changes
They have less total body water than younger adults
-makes them more at risk for fluid imbalances
-more likely to take drugs that effect electrolyte balances
What are the 2 causes of hyponatremia
What are the causes of hypernatremia?
Hypo:
Sodium loss: vomiting, diarrhea, and diuretic use
Dilution of sodium in the blood: inappropriate admission of hypotonic IVF's leading to water intoxication
Hyper:
Sodium gain: inappropriate admin of hypertonic IVF's and Cushing syndrome
Water loss
This type of acid-base imbalance arises from an increase in metabolic acid or a decrease in bicarb. The kidneys are unable to excrete enough metabolic acids which then cause them to accumulate in the blood. This results in a decreased level of consciousness
This is normally causes by diarrhea which leads to a ton of bicarb loss
Metabolic acidosis
What are CLABI's
Central line associated Blood stream infections
- Involves intravascular catheters that terminate at or close to the heart
-rates are going down
- 18,000 in 2019 according to CDC
-Need proper insertion and proper nursing management