Chapter 16 Fluid and Chemical Balance

Body Fluid Body fluid is a mixture of: Water Electrolytes Nonelectrolytes Blood cells

Fluid Transport Mechanisms Osmosis Filtration Passive diffusion Facilitated diffusion Active transport

Assessing a Client’s Fluid Status Signs of deficit or excess Physical assessment Measurement of intake Output volumes Intake and output (I&O) tool Loss over 24-hour period

Common Fluid Imbalances Hypovolemia: low volume in extracellular fluid compartments Hypervolemia: excess water in intravascular fluid compartment Third-spacing: movement of intravascular fluid to nonvascular fluid compartments

Restoring Fluid Volume Treating the cause of hypovolemia Increasing oral intake Administering IV fluid replacements Controlling fluid losses Using a combination of these measures

Reducing Fluid Volume Treating the disorder contributing to the increased fluid volume Restricting or limiting oral fluids Reducing salt consumption Discontinuing IV fluid infusions or reducing the infusing volume Administering drugs that promote urine elimination Using a combination of the above interventions

Administering Intravenous Fluids Maintain or restore fluid balance when oral replacement is inadequate or impossible Maintain or replace electrolytes Administer water-soluble vitamins Provide a source of calories Administer drugs Replace blood and blood products

Question Is the following statement true or false? Reducing salt consumption helps restore fluid volume.

Answer False. Reducing salt consumption helps reduce fluid volume.

Crystalloid and Colloid Solutions Crystalloid solutions are made of water and other uniformly dissolved crystals such as salt and sugar Colloid solutions are made of water and molecules of suspended substances such as blood cells and blood products (such as albumin)

Types of Intravenous Solutions Isotonic: contains the same concentration of dissolved substances as normally found in plasma Hypotonic: contains fewer dissolved substances than normally found in plasma Hypertonic: more concentrated than body fluid and draws cellular and interstitial water into the intravascular compartment

IV Solutions

Question Is the following statement true or false? Blood is an example of crystalloid solution.

Answer False. Blood is an example of colloid solution.

Types of Tubing Primary or secondary tubing Vented or unvented tubing Microdrip or macrodrip chamber Unfiltered or filtered tubing Needle or needleless access ports

Unvented and Vented Tubing

Techniques for Infusing Intravenous Solutions Gravity infusion Electronic infusion devices Infusion pumps Volumetric controllers

Vein Selection Venipuncture device is inserted in veins of: Hand in adults Scalp in child Forearm in adults

Complications With IV Administration Circulatory overload Infiltration Phlebitis Thrombus formation Pulmonary embolus Infection Air embolism

Inserting an Intermittent Venous Access Device When client no longer needs continuous infusions of fluid When client needs intermittent IV medication When client needs emergency IV fluid or medications

Intermittent Venous Access Device

Blood Administration Blood collection and storage Blood safety Blood compatibility Blood transfusion Blood transfusion equipment Catheter or needle gauge Blood transfusion tubing

Transfusion Reactions Febrile nonhemolytic transfusion reaction Viral infection Bacterial infection Acute hemolytic reaction Anaphylactic reaction

Parenteral Nutrition Intravenous administration of nutrients such as protein, carbohydrate, fat, vitamins, minerals, and trace elements Peripheral parenteral nutrition Total parenteral nutrition Lipid emulsions

Question Is the following statement true or false? The venipuncture device is inserted in hand veins in infants or small children.

Answer False. The venipuncture device is inserted in scalp veins in infants or small children.

General Gerontologic Considerations Older adults at risk for fluid and electrolyte imbalances due to cardiac meds and chronic conditions Encourage fluid intake to keep oral mucosa moist and provides hydration Offer noncaffeinated beverages; offer fluids at non-meal times When fasting before procedures, ensure prior increased oral fluid intake

General Gerontologic Considerations (cont’d) Indicators of dehydration Test skin turgor over sternum Mental status changes Increased pulse and respiration rates Decreased blood pressure Dark, concentrated urine with high specific gravity

General Gerontologic Considerations (cont’d) Indicators of dehydration (cont’d) Dry mucous membranes Warm skin, furrowed tongue Low urine output Hardened stools