1 second semester 15 - 16 chapter 16 fluid and chemical balance bader a. el safadi bsn, msc...

1Second semester 15 - 16

Chapter 16

Fluid and Chemical Balance

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Fluid and Chemical Balance

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


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


4

Average distribution of body fluid



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)



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



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



Assessing a Client’s Fluid Status: Output

Urine

Emesis (vomitus)

Blood loss

Diarrhea

Wound or tube drainage

Aspirated irrigations



Assessing Fluid Status

Calibrated containers used to measure liquid

volumes.



Intake and output record



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



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 )



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 )



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



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



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


IV Solutions

A. Isotonic solutions

B. Hypotonic solutions (cell swelling)

C. Hypertonic solutions (cell shrinkage)


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


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


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)


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)


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.


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


Techniques for Infusing Intravenous Solutions

1. Gravity infusion

2. Electronic infusion devices

Infusion pumps

Volumetric controllers


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


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


calculating flow rate


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


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


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


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


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


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


Figure 16-20 • Blood transfusion tubing.


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


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


Figure 16-21 • Central venous catheter inserted into the subclavian vein and threaded into the superior vena cava.

1 second semester 15 - 16 chapter 16 fluid and chemical balance bader a. el safadi bsn, msc...

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