Fluid Balance

Sources of water: - Liquids - Foods - Metabolism byproduct

Average Adult Intake Liquids = 1600 Food = 700 Metab. = hour = 2500

Average Adult Output Urine = 1500 Sweat = 500 Water vapor = 300 Feces = hour total = 2500

Maintaining Fluid Balance Need to be hydrated in all body areas If fluid balance is upset, problems can occur

Fluid Volume Excess Retention of water and Na in the ECF Overhydration

Fluid Volume Excess Causes ? –Inc. intake –Dec. u/o –Physical Disorders –Excess Na –Stress/Trauma

Edema Symptom of many disorders Types of edema

Fluid Volume Deficit Deficiency of fluid & electrolytes in the ECF Dehydration

Fluid Volume Deficit Causes ? –Inadequate intake –Loss of body fluids –Prolonged fever –Inability of body to conserve water

Assessing Fluid Balance Assess the s/s of various systems NOT JUST ONE!!

Calculating I & O Intake: all fluids consumed IV’s tube feeds, irrigations some foods

Clear liquid diet Water Tea Black coffee (sweeten) gingerale broth

Full liquid diet Ice cream Milk Pudding

Output Urine Emesis Stools (esp. if loose) Drainage from tubes

Recording I & O Teach pt and family to save output and tray transcribe to graphic remember: 1 ounce = 30 cc

Intravenous solutions Instilled into the pt.’s vein includes solutions of water, chemical, blood and blood products

Purposes of IV’s Restore fluid balance Prevent fluid imbalance Replace electrolytes Provide nutrition (TPN) Administer meds

Purposes of IV’s (cont) Establish IV access Replace blood components

Types of IV Solutions Isotonic Hypotonic Hypertonic

Isotonic solutions Contain equal amount of dissolved particles as normally found in plasma

Examples of Isotonic 0.9% Sodium Chloride (Normal Saline) 5% dextrose in water (D5W) Lactated ringers (LR) D5NS (0.9% Sodium Chloride)

Hypotonic solutions Contain less dissolved particles than normally found in plasma

Hypotonic (cont.) Shifts F/E out of intra- vascular compartment, hydrating intra-cellular/ interstitial areas.

Examples of hypotonic 0.45% sodium chloride (Normal Saline) or 1/2 NS D5 1/2 NS (0.45%) D5 1/3 NS (0.33%) D5 1/4 NS (0.225%)

Hypertonic solutions Contain higher amount of dissolved particles than normally found in plasma draws F/E into intra- vascular from intracell.

Examples of hypertonic 10% dextrose 3% sodium chloride

Normal saline 0.9% Sodium Chloride Only solution to be used for blood or blood product transfusions!!

Electrolytes Often added to IV’s Most common is KCL Measured in: milliequivalents mEq

Electrolytes (cont.) Intracellular: most common is KCL Extracellular: most common is NACL

Nursing responsibilities Know policy/procedure Check MD order and agree with it!! Check solution/additive Check rate

Nursing responsibilities Check and document site - no erythema, edema or pain Always safeguard site!

Blood transfusion responsibility If you suspect reaction: - stop the transfusion - open saline wide - call MD - notify blood bank

TPN Hyperalimentation - administration of nutrients thru special IV into vein - carbos, fats, proteins

Calculating IV Flow Rates If using infusion pump: -need to calculate and program ml or cc / hour Examples on board!!

Calculating without a pump: Influencing rate: - size of IV catheter - height of solution - position of site

Calculating Rates ml. of soln. X DRF hrs. to admin. 60(min/hr)

Drop Rate Factors Macrodrip: 10, 15, 20 - most common Microdrip: 60 Will list DRF on package

Examples 1000 cc over 8 hours with DRF of X 20 = or 42 drops/min

Can Simplify 1. Find cc/hr. 2. If DRF 20, Divide cc/hr by 3. If DRF 15, Divide cc/hr by 4 If DRF 10, Divide cc/hr by 6

How did we simplify? 2. Took second part of equation DRF or 20 =

Example 1000 cc over 8 hours with DRF of = 125 cc/hr = 41.6 or 42 3 drops/min