Scott Gardner TCC Nursing Q3S05 N132 Fluid Imbalance
Terms
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What is the most common fluid and electroylte imbalance in the US?
What is the morbidity rate from this imbalance? -
Dehydratation
17-45% - Describe ECFVD and the Level it can be manifested in.
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Extra Cellular Fluid Volume Deficite, more commonly called dehydration.
Mild 1-2L 2%
Moderate 3-5L 5%
Severe 5-10L 8% - What is the average daily fluid intake from fluids and solid foods?
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Fluid 1500-2000ml
Solid 800ml - Who is at greatest risk for dehydration?
- Nursing home residents over the age of 85
- What is another name for Third Spacing, and where is it commonly seen?
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Ascites is a common name for Third Spacing.
It is seen in the peritoneal, pericardial, pleural and join cavaties. - What are the three spaces wehre fluid is seen?
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Inside the Cells (Intracellular)
Around the Cells (Interstitial)
The Bloodstream (Intravascular) - What is the most accurate measurement of fluid volume status?
- Weight.
- Is thirst always a good tool to measure ECFVD?
- No, thirst is diminished in older adults.
- When is a client considered to have oliguria?
- When urine output is between 10-500ml/day (16-20ml/h)
- What vital sign changes are seen with inadequate fluid volumes?
- Decrease in SBP, weak pulse, decrease in central venous pressure. Every L of lost fluid caused cardiac output to decrease by 1L/min. HR to increase 8bpm and core temperature to increase 0.3C
- Describe some clinical manifestations of Cellular Dehydration.
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MM of the mouth and eyes become dry.
Lips crack, tongue furrows,
swallowing is difficult.
Skin tenting is seen.
Feces become hard and less numerous. - Describe some diagnostic findings of fluid deficite.
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Osmolality >295
Plasma Na >145
BUN > 25
Plasma Glucose >120
Hematocrit >55%
Urine Specific Gravity >1.030 - Is Cola a good source of oral Fluid Volume Replacement?
- No, they don't contain adequate electolyte, sugar content may lead to osmotic diuresis, caffeine may lead to diuresis.
- What is a danger of giving IV fluids too quickly?
- Cerebral Edema
- Describe D5W.
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It is Hypotonic.
50g dextrose, no electorlytes
Replaces deficites of total body water. - Describe NS or 0.9%NS
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It is Isotonic
154mEq/L of Na and Cl
Given for ECF deficites in patients with low Na/CL
Given before/after infusion of blood products. - Describe LR
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Lactated Ringers * Isotonic
Na/K/Ca/Cl/Lactate
Burns/Bleeding/Bile Loss/Diarrhea.
No Mg or PO4 - Describe D5/LR
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Lactated Ringers with Descrose
Hypertonic - Describe D5/NS
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Hypertonic
Dextrose and Normal Saline - Describe D5/0.45NS
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Hypertonic
D5 and a 1/2
Used as a Maintenance fluid - Describe D5/0.225
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Hypertonic
D5 and a 1/4
Used as a Maintainence fluid - What is the ratio of ice chips to fluid water?
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2/1
1 Cup of Ice Chips = 1/2 C of Water - Why is tenting not appropriate tool for measuring fluid volumes in older adults?
- There is a loss of adipose tissue which causes tenting in addition to fluid volumes.
- Name two ways that ECFVE can develop.
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Extra Cellurar Fluid Volume Excess can come from 1)Simple Overloading of Fluids
2)Filure to excrete fluids. - What is anasarca?
- Massive fluid retention.
- Provide some of the typical laboratory findings with FVE.
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Plasma Osmalality <275
Plasma Na <135mEq/L
Hematacrit <45%
Specifici gravity <1.010
BUN <8mg/dl - Define 3rd Spacing.
- Fluid that shifts into the interstitial space and remains there.
- What type of therapy is IV fluid and electrolyte?
- Crystalloids
- What type of IV fluid is a colloid?
- Blood and blood products
- Name the three types of infusion based fluid replacements.
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TPN - Total Parenteral Nutrition
Crystalloid - IV Fluids and Lytes
Colloids - IV Blood and Blood Products - What is a VAD?
- Vascular Access Device
- Name three types of VAD.
- Valcular Access Devices include Catheters, Cannulas, or Infusion ports designed for repeated access to the vascular system.
- When are peripherally placed catheters used?
- For short term fluid replacement or post-operative antibiotic administration.
- When are central line catheters or Peripherally Inserted Catheters used?
- Long term IV therapy.
- Define a Macrodrip Tubing.
- One that delivers drops that are 10-15gtt/ml.
- Define a Microgrip Tubing
- One that delivers drops that are 60gtt/ml.
- When should KCl be given IV Push?
- NEVER. It can be fatal.
- Why is the foot avoided as a placement site for an IV in adults?
- Development of Thrombophlebitis.
- Name 3 Isotonic IV Solutions
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NS 0.9%
Lactated Ringers
D5W Dextrose 5% in Water - What can be said about Dextrose in Saline Solutions?
- They are always Hypertonic
- What parts of IV Fluid Administration can be delegated to AP?
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The Venapuncture and IV Placement CAN NOT be delegated.
-AP should advise of burning at site
-Advise if flowrate has changed
-Advise if dressing gets wet
-Advise nurse if fluid in bag becomes low -
What size needle is appropritae for
-Fluid placement?
-Surgery? -
-Fluid Therapy 22gage is appropriate
-Surgery requires 16-18 guage. - What are benefits and risks for longer tubing?
- Longer allows for mobility, but also increases risk for infection, and tripping hazzards.
- How far above the proposed site of placment should the tourniqute be placed?
- 4-6 Inches.
- What are some common IV sites for adults?
- Cephalic, basilic and median cubital.
- What are some rules for selecting an IV site?
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Use the Non-Dominate arm, with the most distal site possible.
Avoid areas that are painful to palpation.
Avoid site that will interfere with ADLs. - How many steps are there in Infiltration scale?
- 5 which include 0-4
- When should a bag of IV fluids be changed?
- When there is less than 50ml in the old bag.
- When changing a bag, how much fluid should be in the drip chanmber?
- Between 1/3 and 1/2 full.
- What is an infiltration?
- Occurs when IV fluids enter the surrounding space around the venipuncture site.