ppt chapter 16

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 16

Fluid and Chemical Balance

Chapter 16

Fluid and Chemical Balance


• Body fluid is a mixture of:

– Water

– Electrolytes

– Nonelectrolytes

– Blood cells

Body Fluid Body Fluid


• Osmosis

• Filtration

• Passive diffusion

• Facilitated diffusion

• Active transport

Fluid Transport MechanismsFluid Transport Mechanisms


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


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


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


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


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


QuestionQuestion

•Is the following statement true or false?

Reducing salt consumption helps restore fluid volume.


AnswerAnswer

False.

Reducing salt consumption helps reduce fluid volume.


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)


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


IV SolutionsIV Solutions


QuestionQuestion


Blood is an example of crystalloid solution.


AnswerAnswer

False.

Blood is an example of colloid solution.


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


Unvented and Vented TubingUnvented and Vented Tubing


Techniques for Infusing Intravenous Solutions

Techniques for Infusing Intravenous Solutions

• Gravity infusion

• Electronic infusion devices

– Infusion pumps

– Volumetric controllers


Vein SelectionVein Selection

• Potential venipuncture device insertion locations:

– Hand or forearm in adults

– Scalp in child


Complications With IV AdministrationComplications With IV Administration

• Circulatory overload

• Infiltration; Phlebitis

• Thrombus formation

• Pulmonary embolus

• Infection; Air embolism


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


Intermittent Venous Access Device Intermittent Venous Access Device


Blood AdministrationBlood Administration

• Blood collection and storage

• Blood safety

• Blood compatibility

• Blood transfusion

• Blood transfusion equipment

– Catheter or needle gauge

– Blood transfusion tubing


Transfusion Reactions Transfusion Reactions

• Incompatibility

• Febrile

• Septic

• Allergic

• Moderate chilling

• Overload

• Hypocalcemia


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


QuestionQuestion


The venipuncture device is inserted in hand veins in infants or small children.


AnswerAnswer

False.

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


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


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




• Indicators of dehydration (cont’d)

– Dry mucous membranes

– Warm skin, furrowed tongue

– Low urine output

– Hardened stools

ppt chapter 16

Health & Medicine

fluid balance

fluid replacements

fluid losses

increased fluid volume

iv fluid infusions

emergency iv fluid

fluid consumedinstilled

nonvascular fluid compartments