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Transcript of Ppt chapter 16
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 16
Fluid and Chemical Balance
Chapter 16
Fluid and Chemical Balance
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Body fluid is a mixture of:
– Water
– Electrolytes
– Nonelectrolytes
– Blood cells
Body Fluid Body Fluid
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Osmosis
• Filtration
• Passive diffusion
• Facilitated diffusion
• Active transport
Fluid Transport MechanismsFluid Transport Mechanisms
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessing a Client’s Fluid StatusAssessing a Client’s Fluid Status
• Intake and output (I&O) measurement
• Intake: Sum of all fluid consumed/instilled
• Output: Sum of liquid eliminated from the body
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Fluid ImbalancesCommon 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Restoring Fluid VolumeRestoring Fluid Volume
• Treating the cause of hypovolemia
• Increasing oral intake
• Administering IV fluid replacements
• Controlling fluid losses
• Using a combination of these measures
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reducing Fluid VolumeReducing 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Intravenous FluidsAdministering 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
•Is the following statement true or false?
Reducing salt consumption helps restore fluid volume.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False.
Reducing salt consumption helps reduce fluid volume.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Crystalloid and Colloid SolutionsCrystalloid and Colloid Solutions
Crystalloid solutions: made of water and other uniformly dissolved crystals such as salt and sugar
Colloid solutions: made of water and molecules of suspended substances such as blood cells and blood products (such as albumin)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Intravenous SolutionsTypes 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
IV SolutionsIV Solutions
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QuestionQuestion
•Is the following statement true or false?
Blood is an example of crystalloid solution.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False.
Blood is an example of colloid solution.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of TubingTypes of Tubing
• Primary or secondary tubing
• Vented or unvented tubing
• Microdrip or macrodrip chamber
• Unfiltered or filtered tubing
• Needle or needleless access ports
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Unvented and Vented TubingUnvented and Vented Tubing
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Techniques for Infusing Intravenous Solutions
Techniques for Infusing Intravenous Solutions
• Gravity infusion
• Electronic infusion devices
– Infusion pumps
– Volumetric controllers
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Vein SelectionVein Selection
• Potential venipuncture device insertion locations:
– Hand or forearm in adults
– Scalp in child
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Complications With IV AdministrationComplications With IV Administration
• Circulatory overload
• Infiltration; Phlebitis
• Thrombus formation
• Pulmonary embolus
• Infection; Air embolism
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Inserting an Intermittent Venous Access Device
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
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Intermittent Venous Access Device Intermittent Venous Access Device
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Blood AdministrationBlood Administration
• Blood collection and storage
• Blood safety
• Blood compatibility
• Blood transfusion
• Blood transfusion equipment
– Catheter or needle gauge
– Blood transfusion tubing
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Transfusion Reactions Transfusion Reactions
• Incompatibility
• Febrile
• Septic
• Allergic
• Moderate chilling
• Overload
• Hypocalcemia
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Parenteral NutritionParenteral Nutrition
• Intravenous administration of nutrients such as protein, carbohydrate, fat, vitamins, minerals, and trace elements
– Peripheral parenteral nutrition
– Total parenteral nutrition
– Lipid emulsions
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
•Is the following statement true or false?
The venipuncture device is inserted in hand veins in infants or small children.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False.
The venipuncture device is inserted in scalp veins in infants or small children.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic ConsiderationsGeneral 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations (cont’d)
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations (cont’d)
General Gerontologic Considerations (cont’d)
• Indicators of dehydration (cont’d)
– Dry mucous membranes
– Warm skin, furrowed tongue
– Low urine output
– Hardened stools