fluid balance sources of water: - liquids - foods - metabolism byproduct
TRANSCRIPT
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Fluid Balance
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Fluid Balance•Sources of water: - Liquids - Foods - Metabolism byproduct
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Average Adult Intake
•Liquids = 1600•Food = 700•Metab. = 200 -----------24 hour = 2500
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Average Adult Output
•Urine = 1500•Sweat = 500•Water vapor = 300•Feces = 20024 hour total = 2500
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Maintaining Fluid Balance
•Need to be hydrated in all body areas
•If fluid balance is upset, problems can occur
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Fluid Volume Excess
•Retention of water and Na in the ECF
•Overhydration
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Fluid Volume Excess
•Causes ?–Inc. intake–Dec. u/o–Physical Disorders–Excess Na–Stress/Trauma
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Edema
•Symptom of manydisorders•Types of edema
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Fluid Volume Deficit
•Deficiency of fluid & electrolytes in the ECF
•Dehydration
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Fluid Volume Deficit
•Causes ?–Inadequate intake–Loss of body fluids–Prolonged fever–Inability of body to conserve water
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Assessing Fluid Balance
•Assess the s/s of various systems
•NOT JUST ONE!!
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Calculating I & O
Intake:•all fluids consumed•IV’s•tube feeds, irrigations•some foods
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Clear liquid diet•Water•Tea•Black coffee (sweeten)•gingerale•broth
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Full liquid diet•Ice cream•Milk•Pudding
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Output•Urine•Emesis•Stools (esp. if loose)•Drainage from tubes
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Recording I & O•Teach pt and family to save output and tray
•transcribe to graphic•remember: 1 ounce = 30 cc
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Intravenous solutions
•Instilled into the pt.’s vein
•includes solutions of water, chemical, blood and blood products
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Purposes of IV’s•Restore fluid balance•Prevent fluid imbalance•Replace electrolytes•Provide nutrition (TPN)•Administer meds
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Purposes of IV’s (cont)
•Establish IV access•Replace blood components
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Types of IV Solutions
•Isotonic•Hypotonic•Hypertonic
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Isotonic solutions
•Contain equal amount of dissolved particles as normally found in plasma
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Examples of Isotonic
•0.9% Sodium Chloride (Normal Saline)
•5% dextrose in water (D5W)•Lactated ringers (LR)•D5NS (0.9% Sodium Chloride)
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Hypotonic solutions
•Contain less dissolved particles than normally found in plasma
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Hypotonic (cont.)
•Shifts F/E out of intra-vascular compartment, hydrating intra-cellular/
interstitial areas.
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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%)
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Hypertonic solutions
•Contain higher amount of dissolved particles than normally found in plasma
•draws F/E into intra-vascular from intracell.
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Examples of hypertonic
•10% dextrose•3% sodium chloride
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Normal saline•0.9% Sodium Chloride•Only solution to be used for blood or blood product transfusions!!
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Electrolytes
•Often added to IV’s•Most common is KCL•Measured in: milliequivalents mEq
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Electrolytes (cont.)
•Intracellular: most common is KCL•Extracellular: most common is NACL
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Nursing responsibilities
•Know policy/procedure•Check MD order and agree with it!!
•Check solution/additive•Check rate
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Nursing responsibilities
•Check and document site
- no erythema, edema or pain
•Always safeguard site!
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Blood transfusion responsibility
•If you suspect reaction: - stop the transfusion - open saline wide - call MD - notify blood bank
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TPN•Hyperalimentation - administration of nutrients thru special IV into vein
- carbos, fats, proteins
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Calculating IV Flow Rates
•If using infusion pump: -need to calculate and program ml or cc / hour
•Examples on board!!
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Calculating without a pump:
•Influencing rate: - size of IV catheter - height of solution - position of site
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Calculating Rates
ml. of soln. X DRFhrs. to admin. 60(min/hr)
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Drop Rate Factors•Macrodrip: 10, 15, 20 - most common•Microdrip: 60
Will list DRF on package
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Examples•1000 cc over 8 hours with DRF of 20•1000 X 20 = 41.6 8 60 or 42
drops/min
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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, Dividecc/hr by 6
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How did we simplify?
2. Took second part of equation
DRF or 20 = 1 60 60 3
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Example•1000 cc over 8 hours with DRF of 20
•1. 1000 = 125 cc/hr
8•2. 125 = 41.6 or 42
3 drops/min