1 second semester 15 - 16 chapter 16 fluid and chemical balance bader a. el safadi bsn, msc...
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1Second semester 15 - 16
Chapter 16
Fluid and Chemical Balance
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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2Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Body fluid is a mixture of water, chemicals (called electrolytes and nonelectrolytes), and blood cells.
Water, the vehicle for transporting the chemicals, is the very essence of life.
Water is not stored in any great reserve, daily replacement is the key to maintaining survival.
Fluid and Chemical Balance
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3Second semester 15 - 16
Body FluidBody fluid is a mixture of:Water: human body has 45% to 75% Electrolytes: have electrical charge Nonelectrolytes: do not have electrical
chargeBlood cells: RBCs, Leukocytes, WBCs,
Platelets
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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4
Average distribution of body fluid
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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5Second semester 15 - 16
Intracellular / Extracellular Fluid
Intracellular fluid: Fluid inside cells (greatest portion of water in the body)
Extracellular fluid: Fluid outside cells
** Extracellular fluid is one of the following:
1. Interstitial fluid (fluid in tissues)
2. Intravascular fluid (the watery plasma, or serum, portion of blood)
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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6Second semester 15 - 16
Assessing a Client’s Fluid Status
Intake and output (I&O) measurement: one
tool to assess fluid status by keeping record over
a 24hr period.
Intake: Sum of all fluid consumed/instilled
Output: Sum of liquid eliminated from the
body
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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7Second semester 15 - 16
Assessing a Client’s Fluid Status: Intake
All liquids client drinks
IV solutions given
Liquid equivalent of melted ice chips, which is half
of the frozen volume
Foods that liquidize when swallowed: gelatin, ice
cream, thin cooked cereal
Fluid instillations: tube feeds or tube irrigations
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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8Second semester 15 - 16
Assessing a Client’s Fluid Status: Output
Urine
Emesis (vomitus)
Blood loss
Diarrhea
Wound or tube drainage
Aspirated irrigations
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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9Second semester 15 - 16
Assessing Fluid Status
Calibrated containers used to measure liquid
volumes.
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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10Second semester 15 - 16
Intake and output record
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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11Second semester 15 - 16
Hypovolemia:
low volume in extracellular fluid compartments If untreated,
hypovolemia results in dehydration
Dehydration: fluid deficit in both extracellular & intracellular
compartments. In addition to weight loss, it is evidenced by
decreased skin turgor (usually checked over the sternum)
Physical S&S of dehydration:
Acute weight. loss, Oliguria, concentrated urine, sunken eyes,
poor skin turgor, low BP, weak rapid pulse, dizziness.
Common Fluid Imbalances
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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12Second semester 15 - 16
Hypervolemia:
Excess water in the intravascular fluid compartment
Edema (excess fluid is distributed to the interstitial space).
Dependent edema: fluid accumulates in dependent areas
of the body (influenced by gravity)
Common Fluid Imbalances ( cont‘d )
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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13Second semester 15 - 16
Third-spacing: movement of intravascular fluid to nonvascular
fluid compartments where it becomes trapped and useless
Peritoneum common place for fluid build-up
Common Fluid Imbalances ( cont‘d )
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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14Second semester 15 - 16
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
Reducing Fluid Volume
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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15Second semester 15 - 16
Intravenous Fluids administration
Intravenous (IV) fluids are solutions infused into a client’s vein to:
Maintain or restore fluid balance when oral replacement is inadequate or impossible
Maintain or replace electrolytesAdminister water-soluble vitaminsProvide a source of caloriesAdminister drugsReplace blood and blood products
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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16Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Isotonic: Contains the same concentration of dissolved
substances as normally found in plasma (0.9% saline (NS), Ringer's lactate )
Hypotonic: Contains fewer dissolved substances than normally
found in plasma (Ex: 0.45% sodium chloride)
Hypertonic: More concentrated than body fluid and draws
cellular and interstitial water into the intravascular compartment
Types of Intravenous Solutions
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17Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
IV Solutions
A. Isotonic solutions
B. Hypotonic solutions (cell swelling)
C. Hypertonic solutions (cell shrinkage)
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18Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Venipuncture
(accessing the venous system by piercing a vein
with a needle)
Venipuncture device is inserted in veins of:
Hand or forearm in adults
Scalp in child
Venipuncture
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19Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
1. Use veins on the non dominant side.this reduces the potential for dislodging the device as a
result of movement and use.
2. Do not use foot and leg veins.using foot and leg veins restricts mobility and increases the
potential for blood clots.
3. If possible, do not use a vein on the side of previous breast surgery or in which vascular surgery has been performed for kidney dialysis.
using such veins further compromises circulation and increases the potential for infection and poor healing.
Selecting a Venipuncture Site
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20Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
4. Choose a vein in a location unaffected by joint it's movement.
a venipuncture device in such a location could become displaced more easily.
5. Look for a large vein, if a large-gauge needle or catheter is necessary.
matching the needle and vein size prevents compromising circulation.
6. Avoid using veins on the inner surface of the wrist.this prevents pain and discomfort.
Selecting a Venipuncture Site (cont'd)
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21Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
7. Look for a vein proximal to the current site or in the opposite hand or arm.
This promotes healing and decreases the risk of fluid leaking from the vein into the tissue.
8. Feel and look for a fairly straight vein.It is easier to thread the device into a straight vein.
9. Do not use a vein that appears inflamed or if the skin over the area looks impaired in any way.
Use of such a site creates additional trauma
Selecting a Venipuncture Site (cont'd)
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22Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
IV Solutions
Before preparing the solution, the nurse inspects the container and determines that:Solution is the one prescribedSolution is clear and transparentExpiration date has not elapsedNo leaks are presentA separate label is attached identifying the type & amount of other drugs added and is the one the MD ordered.
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23Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Types of Tubing1. Microdrip (small drops) chamber:
standard volume of 60 drops/mL
2. Macrodrip (large drops) chamber: usually 15, and 20 drops/mL.
Drop factor (number of drops/mL) is important in calculating infusion rate when infusion is done by gravity
3. Filtered tubing:
removes air bubbles, un-dissolved drugs, bacteria, large substances
Ex: PRBCs, parental nutrition, pediatrics
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24Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Techniques for Infusing Intravenous Solutions
1. Gravity infusion
2. Electronic infusion devices
Infusion pumps
Volumetric controllers
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25Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Complications associated with the infusion of IV solutions are :Circulatory overload (intravascular volume that
becomes excessive).Infiltration (escape of IV fluid into the tissue). Phlebitis (inflammation of a vein).Thrombus formation (stationary blood clot).Pulmonary embolus (blood clot that travels to the lung).Infection (growth of microorganisms at the site or within
the blood stream), and Air embolism (bubble of air traveling within the vascular
system).
Complications With IV Administration
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26Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Regulating the Infusion Rate
The nurse is responsible for calculating, regulating, and maintaining the rate of infusion according to the physician's order.
If an infusion device is used, the electronic equipment is programmed in milliliters per hour.
If the solution is infused without an electronic infusion device (i.e., by gravity), the rate is calculated in drops (gtt) per minute.
Formulas for calculating infusion rates are provided in Box 16-5.
Infusion Monitoring and Maintenance
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27Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
calculating flow rate
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28Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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29Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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30Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
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31Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Because the venipuncture is a type of wound, it is important to inspect the site routinely.
The nurse documents its appearance in the client's record.
A common practice is to change the dressing over the venipuncture site every 24 to 72 hours
Caring for the Site
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32Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Solutions are replaced when they finish infusing or every 24 hours, whichever occurs first (Skill 16-4).
IV tubing is changed every 72 hours, depending on agency policy, with some exceptions.
Replacing Equipment
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33Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Blood is collected, stored, and checked for safety and compatibility before it is administered as a transfusion.
Blood Collection and StorageBlood donors are screened to ensure they are healthy and
will not be endangered by the temporary loss in blood volume. Refrigerated blood can be stored for 21 to 35 days, after which it is discarded.
Blood SafetyOnce collected, the donated blood is tested for syphilis, hepatitis,
and human immunodeficiency virus (HIV) antibodies to exclude administering blood that may transmit these blood-borne
diseases.
Blood Administration
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34Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Antigens determine the characteristic blood group—A, B, AB, and O—and Rh factor. Rh positive means the protein is present; Rh negative means the protein is absent.
Before donated blood is administered, the blood of the potential recipient is typed and mixed, or cross-matched, with a sample of the stored blood to determine whether the two are compatible. To avoid an incompatibility reaction, it is best to administer the same blood group and Rh factor.
Blood Compatibility
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35Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Before administering blood, the nurse obtains and documents the client's vital signs to provide a baseline for comparison should the client have a transfusion reaction.
Blood Transfusion
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36Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Catheter or Needle Gaugeit generally is infused through a 16- to 20-gauge—
preferably an 18-gauge—catheter or needle.
Blood Transfusion TubingBlood is administered through tubing referred to as a
Y-set (Fig. 16-20).
The normal saline always is administered before the blood is hung and follows after the blood has been infused. It also is used during the infusion if the client has a transfusion reaction
Blood Transfusion Equipment
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37Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Figure 16-20 • Blood transfusion tubing.
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38Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Usually occur within first 5-15 minutes of the transfusion
Staff remains with client for the 1st 15 minutes Incompatibility Febrile Septic Allergic Moderate chilling Overload Hypocalcaemia
Transfusion Reactions
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39Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Total parenteral nutrition (TPN; hypertonic solution of nutrients designed to meet almost all caloric and nutritional needs) is preferred for clients who are severely malnourished or may not be able to consume food or liquids for a long period.
Because TPN solutions are extremely concentrated, they must be delivered to an area where they are diluted in a fairly large volume of blood. This excludes peripheral veins.
TPN solutions are infused through a catheter inserted into the subclavian or jugular vein; the tip terminates in the superior vena cava.
This type of a catheter is referred to as a central venous catheter
Total Parenteral Nutrition
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40Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance
Figure 16-21 • Central venous catheter inserted into the subclavian vein and threaded into the superior vena cava.