1. Chapter 16 Fluid and Chemical Balance

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

3. Fluid Transport Mechanisms
Osmosis
Filtration
Passive diffusion
Facilitated diffusion
Active transport

4. 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

5. 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

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

7. 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

8. 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

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

10. Answer
False.
Reducing salt consumption helps reduce fluid volume.

11. 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)

12. 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

13. IV Solutions

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

15. Answer
False.
Blood is an example of colloid solution.

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

17. Unvented and Vented Tubing

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

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

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

21. 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

22. Intermittent Venous Access Device

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

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

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

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

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

29. 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

30. 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

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