1. Chapter 16 Fluid and Chemical Balance

2. Body Fluid Body fluid is a mixture of: Water Electrolytes
Nonelectrolytes
Blood cells
WATER --THE VEHICLE FOR TRANSPORTING THE CHEMICALS. WATER IS THE VERY ESSENCE OF LIFE.
ISN’T STORED IN ANY GREAT RESERVE, DAILY REPLACEMENT IS THE KEY TO MAINTAINING SURVIVAL.
DEPENDING ON AGE AND GENDER BODY IS APPX. 45% -75% WATER ON TEST!!!!!!!!!!!!!!
FLUID COMPARTMENTS—
INTRACELLULAR—FLUID INSIDE CELLS—REPRESENTS GREATEST PROPORTION OF WATER IN THE BODY.
EXTRACELLULAR—FLUID OUTSIDE CELLS—HAS 2 PARTS
A. INTERSTITIAL FLUID—FLUID IN THE TISSUE SPACE BETWEEN AND AROUND CELLS
B. INTRAVASCULAR FLUID—WATERY PLASMS, OR SERUM, PORTION OF THE BLOOD
ELECTROLYTES—CHEMICAL COMPOUNDS SUCH AS SODIUM AND CHLORIDE THAT ARE DISSLOVED, ABSORBED AND DISTRIBUTED IN BODY
FLUID AND POSSESS AN ELECTRICAL CHARGE.
COLLECTIVELY CALLED IONS (SUBSTANCE THAT CARRY EITHER A POSITIVE OR NEGATVIE ELECTRICAL CHARGE)
CATIONS—ELECTROLYTES WITH A POSITIVE CHARGE
ANIONS—ELECTROLYTES WITH A NEGATIVE CHARGE
EXAMPLE: MORE POTASSIUM IONS ARE INSIDE CELLS THAN OUTSIDE CELLS TABLE 16-2 PAGE 313
NONELECTROLYTES—CHEMICAL COMPUNDS THAT REMAIN BOND TOGETHER WHEN DISSOLVED IN A SOLUTION AND DO NOT CONDUCT
ELECTRICITY. THE CHEMICAL END PRODUCTS OF CARBOHHYDRATE PROTEIN ANDFAT METABOLISM NAMELY
GLUCOSE, AMINO ACIDS AND FATTY ACIDS PROVIDE A CONTINOUS SUPPLY OF NONELECTROLYTES.
KNOW TABLE 16-2 ON PAGE 313
HAVE TO NORMAL RANGES OF THESE ELECTROLYTES!!!!!!
BLOOD—CONSISTS OF 3 LITERS OF PLAMSA OR FLUID AND 2 LITERS OF BLOOD CELLS FOR A TOTAL CIRCULATING VOLUME OF 5 LITERS
ERYTHROCYTES—RED BLOOD CELLS
LUEKOCYTES—WHITE BLOOD CELLS
PLATELETS—THROMBOCYTES
500 RBC’S=APPX. 30 PLATELTES AND 1 WBC.

3. Fluid Transport Mechanisms
Osmosis
Filtration
Passive diffusion
Facilitated diffusion
Active transport
OSMOSIS-Helps regulate the distribution of water by controlling the movement of fluid from one location to another.
COLLOIDS—undissolved protein substance such as albumin and blood cells within the body that do not readily pass through membranes
FILTRATION—Regulates the movement of water and substances from a compartment where the PRESSURE is higher to one where the PRESSURE is lower. EXAMPLE: COFFEE FILTER
PASSIVE DIFFUSION—The physiologic process in which dissolved substances such as electrolytes and gases move from a HIGHER
CONCENTRATION to a LOWER CONCENTRATION through a semi-permeable membrane. No energy is required for
this process. Keeps electrochemical neutrality.
FACILIATED DIFFUSION—The process in which certain dissolved substances require the ASSISTANCE OF A CARRIER MOLECULE to pass from
one side of a semi-permeable membrane to the other. It regulates chemical balance. It distributes substances
from an area of higher concentration to one that is lower. EXAMPLE: GLUCOSE DISTRIBUTED BY FACILIATED
DIFFUSION. INSULIN IS THE CARRIER SUBSTANCE FOR GLUCOSE.
ACTIVE TRANSPORT—A process of chemical distribution that requires an energy source. It involves a substance called
ATP (ADENOSINE TRIPHOSPHATE). It provides energy to drive dissolved chemicals against the concentration gradient.
I.E.—goes from a lower concentration to a higher concentration. Opposite of passive diffusion
EXAMPLE: SODIUM-POTASSIUM PUMP

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
Fluid intake generally averages appx. 2,500 ml per day, but it can range from 1,800 to 3,000 ml per day with a similar volume of fluid loss.
INSENSIBLE LOSSES (UNNOTICABLE AND UNMEASURABLE)—Normal ways we loose fluids—urination, bowels, sweating, breathing and through the skin (glands)
AS FLUID VOLUME EXPANDS, THE KIDNEYS EXCRETE A PROPORTIONATE VOLUME OF WATER TO MAINTAIN OR RESTORE PROPER BALANCE.
LOOK AT PAGE 314 TABLE 16-3 INTAKE AND OUTPUT AREAS
GO OVER DIFFERENT TYPES OF INTAKE AND OUTPUT!!!!!!!!!!!!

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
Hypovolemia can lead to dehydration if untreated.
Evident by decreased skin tugor. TENTING ON CHEST IS BEST PLACE TO CHECK. WHY?---
HYPERVOLEMIA—higher than normal concentration of volume of water in the intravascular fluid compartment. EDEMA
THIRD-SPACING—MOVEMENT OF INTRAVASCULAR FLUID TO NONVASCULAR FLUID COMPARTMENTS WHERE IT BECOMES TRAPPED AND USELESS. MANIFESTED BY TISSUE SWELLING OR FLUID THAT ACCUMULATES IN A BODY CAVITY SUCH AS THE PERITONEUM. ASSOCIATED WITH HYPOALBUMINEMIA.

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
SO, HOW DO WE FIX IT? SEE ABOVE FOR ANSWERS.

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
SO, HOW DO WE FIX IT CONTINUED!!!!!!!!!!!!

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
RN HAS TO START BLOOD TRANSFUSION AND MONITOR FOR 1ST 15 MINUTE AND THEN LVN CAN CONTINUE TO MONITOR AFTER THAT.

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

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)
KNOW THE DIFFERENCE!!!!!!

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
YOU HAVE TO KNOW THESE!!!!!!!!!!!!!

13. IV Solutions A=ISOTONIC SOLUTION
B=HYPOTONIC SOLUTION—RE-HYDRATE PATIENTS WITH THIS ONE (VOMITING AND DIARRHEA)
C=HYPERTONIC SOLUTION—RARELY USED

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

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
MICRO DRIP= 10 DROP SET
MACRO DRIP= 60 DROP SET

17. Unvented and Vented Tubing
GREEN = NONVENTED IV SOLUTIONS
WHITE = VENTED NITROGLYCERIN DRIP

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
HAVE TO BE IV CERTIFIED AFTER YOU GET YOUR LVN LICENSE.

20. Complications With IV Administration
Circulatory overload
Infiltration
Phlebitis
Thrombus formation
Pulmonary embolus
Infection
Air embolism
INFILTRATION-Escape of IV fluid into the tissue—KNOW S/S OF COMPLICATIONS
PHLEBITIS—Inflammation of a vein—KNOW S/S OF COMPLICATIONS
THROMBUS FORMATION—Stationary blood clot
PULMONARY EMBOLUS—Blood clot that travels to the lung
AIR EMBOLISM—Bubble of air traveling within the vascular system.

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
BLOOD TYPE O = UNIVERSAL DONOR—GIVE TO ANYBODY
BLOOD TYPE AB = UNIVERSAL RECIPIENTS—CAN GET BLOOD FROM ANYBODY
BLOOD TYPE A&O ARE COMPATIBLE
BLOOD TYPE B&O ARE COMPATIBLE
RH NEGATIVE PERSON SHOULD NEVER RECEIVE RH POSITIVE BLOOD
NEEDLE SIZE FOR BLOOD TRANSFUSION = 16 TO 20 GAUGE, PERFERABLY 18 GUAGE
THIS ALLOWS BLOOD TO BE GIVEN IN THE REQUIRED 4 HOUR PEROID
GIVE BY Y TUBING

24. Transfusion Reactions
Febrile nonhemolytic transfusion reaction
Viral infection
Bacterial infection
Acute hemolytic reaction
Anaphylactic reaction
INCOMPATIBILITY—S/S HYPOTENSION, RAPID HEART RATE, S.O.B., BACK PAIN, FLUSHING
STOP BLOOD TRANSFUSION
CALL FOR HELP
GIVE O2
TRENDELBURG FOR HYPOTENSION
ER DRUGS IF NEEDED.
OVERLOAD –CALL MD
ALLERGIC REACTION—STOP BLOOD, ASSESS PT., REPORT FINDINGS, GIVE MEDS PRN.

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
LOOKS MILKY WHITE
IS HYPERTONIC
GIVEN IN CENTRAL VEIN-SUBCLAVIAN AREA PR PICC LINE IN ARM.

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

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

28. 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

29. 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

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