ch 16

infiltration

escape of iv fluid into tissue

how often is tubing replaced

every 72 hours

hypervolemia

excess water in intravascular fluid compartment

interstitial fluid

fluid in the spaces between cells

common fluid imbalances

hypovolemia, hypervolemia, third spacing

transfusion reactions

incompatibility, febrile, septic, allergic, moderate chlling, overload

complications of intravenous therapy

infection, circulatory overload, infiltration, phlebitis, thrombus formation, pulmonary embolus, air embolism

phlebitis

inflamattion of vein

intracellular

inside the cell

Types of Intravenous Solutions

isotonic, hypotonic, hypertonic

hypovolemia

low volume in extracellular fluid compartments

macrodrip speed vs microdrip speed

macro fast, micro slow

colloid solutions

made of water and molecules of suspended substances such as blood cells and blood products

crystalloid solutions

made of water and other uniformly dissolved crystals such as salt and sugar

Why administer intravenous fluids?

maintain or restore fluid balance when oral replacement is inadequate, maintain or replace electrolytes, administer water soluble vitamins, provide a source of calories, administer drugs, replace blood and blood products

hypertonic iv solutions

more concentrated than body fluid and draws cellular and interstitial water into intravascular compartment.

Different types of fluid transport mechanisms

osmosis, filtration, passive diffusion, facilitated diffusion, active diffusion

extracellular

outside the cell

Tubing Selection options for IV

primary, secondary vented, unvented, microdrip, macrodrip unfiltered, filtered needle, needless

thrombus formation

stationary blood clot

third spacing

the movement of intravascular fluid to nonvascular fluid compartments, where it becomes trapped and useless

filtered tubing is typically used for

tpn, high risk for infection, blood, pediatric

How to restore fluid volume

treating the cause of hypovolemia, increasing oral intake, administering IV fluid replacements, controlling fluid losses, using a combination of these measures

body fluid is a mixture of

-water -electrolytes -nonelectrolytes -blood cells

Fluid imbalances: Deficit vs Excess Mucous Membranes

Deficit: dry, sticky Excess: moist

Fluid imbalances: Deficit vs Excess Breathing

Deficit: effortless Excess: dyspnea, orthopnea

Fluid imbalances: Deficit vs Excess Temperature

Deficit: elevated Excess: normal

Fluid imbalances: Deficit vs Excess Jugular neck vein

Deficit: flat Excess: distended

Fluid imbalances: Deficit vs Excess Blood Pressure

Deficit: low Excess: high

Fluid imbalances: Deficit vs Excess Respirations

Deficit: rapid shallow Excess: moist labored

Fluid imbalances: Deficit vs Excess Pulse

Deficit: rapid, weak, thready Excess: full bounding

Fluid imbalances: Deficit vs Excess Cognition

Deficit: reduced Excess: reduced

Fluid imbalances: Deficit vs Excess Urine

Deficit: scant, dark yellow Excess: light yellow

Fluid imbalances: Deficit vs Excess consciousness

Deficit: sleepy Excess: anxious

Fluid imbalances: Deficit vs Excess Eyes

Deficit: sunken Excess: swollen

Fluid imbalances: Deficit vs Excess Skin

Deficit: warm, flushed, dry, poor skin turgor Excess: cool, pale, moist, pitting edema

Fluid imbalances: Deficit vs Excess Energy

Deficit: weak Excess: fatigues easily

Fluid imbalances: Deficit vs Excess Weight

Deficit: weight loss Excess: weight gain

examples of hypertonic solutions

10% dextrose in water (D10W) 20% dextrose in water (D20W) 3%-5% normal saline (3%-5% NS) 5% dextrose in 0.9% normal saline (D5 NS) 5% dextrose in 0.45% normal saline (D5 1⁄2 NS)

length of primary and secondary tubing

110 in and 37 in

examples of hypotonic solutions

2.5% dextrose in water (D2.5W) 0.45% normal saline (1⁄2 NS) 0.33% normal saline (0.33% NS)

examples of isotonic solutions

1)Lactaid Ringers 2) NS (0.9% NaCl) 3) 5% Dextrose

Fluid imbalances: Deficit vs Excess Lungs

Deficit: clear Excess: crackles

Fluid imbalances: Deficit vs Excess Stool

Deficit: dry small volume Excess: bulky

Which fluid below is considered an isotonic solution but works as a hypotonic solution? A. Dextrose 5% in water B. Lactated Ringer's solution C. Dextrose 10% in water D. 0.33% Normal Saline

The answer is A. Dextrose 5% in water (D5W) starts out as an isotonic solution, but ends up working as a hypotonic solution. This occurs because once the dextrose in the solution is used by the body (metabolized), there is only free water left over, which has a low osmolarity and acts as a hypotonic solution.

A patient with diabetes insipidus is most likely to experience what type of fluid volume deficit (dehydration)? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration

The answer is A: hypertonic dehydration. Diabetes insipidus (DI) causes the patient to void a high volume of urine. This is due to a low level of ADH being produced in the body. DI will cause the extracellular compartment to lose mainly water rather than electrolytes. This change in osmolarity will further cause fluid to move from intracellular to extracellular compartment and shrink the cell.

What type of dehydration presents with mainly a loss of water rather than electrolytes (solutes)? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration

The answer is A: hypertonic dehydration. This presents with mainly a loss of water rather than electrolytes (solutes). This is also known as hypernatremia.

What type of fluid volume overload occurs because water moves from the intracellular to the extracellular compartment due to an increase in osmolarity of extracellular fluid which increases body water? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload

The answer is A: hypertonic overload. Hypertonic overload occurs because water has moved from the intracellular to the extracellular compartment. This is due to an increase in osmolarity of the extracellular fluid.

What type of solution below can be used to treat cerebral edema? A. Isotonic B. Hypertonic C. Hypotonic

The answer is B. Cerebral edema is swelling of the brain. Hypertonic solutions dehydrate the cell which is helpful with cerebral edema.

What type of dehydration presents mainly with a loss of electrolytes (solutes) rather than water? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration

The answer is B: hypotonic dehydration. Hypotonic dehydration presents mainly with a loss of electrolytes (solutes) rather than water. This is also known as hyponatremia.

The patient is experiencing a severe case of SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What type of overload is the patient most likely to experience? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload

The answer is B: hypotonic overload. In SIADH, there is too much ADH being released and water is retained. This will increase body water and dilute the extracellular fluid (hence lowering its osmolarity). This will cause water to move from the extracellular to the intracellular compartment and overload both compartments.

What is the fluid compartment that surrounds the outside of the cells and plays a vital role in helping be a medium for electrolytes and other substances to move to and from the cell to the plasma? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is B: interstitial compartment

Which patients below should not receive Lactated Ringer's solution? Select all that apply: A. A patient with a mild case of metabolic acidosis. B. A pre-op patient for abdominal surgery. C. A patient experiencing hyperkalemia. D. A patient with liver failure.

The answer is C and D. Lactated Ringer's solution (LR) contains water, potassium, sodium, chloride, calcium, and lactate. Patients who are experiencing hyperkalemia (high potassium level) should not receive this solution since it already has potassium in it. In addition, a patient with liver failure is not a candidate for LR because it contains lactate. The liver is responsible for converting lactate to bicarbonate. When the liver is failing this conversion process cannot happen, which can lead to the buildup of lactate.

What type of fluid can cause the cell the swell and rupture? A. Isotonic B. Hypertonic C. Hypotonic

The answer is C.

Your patient is receiving 0.45% Normal Saline for hypernatremia. What finding requires you to stop the fluid and notify the doctor? A. decreasing sodium level B. increased urination C. confusion D. polydipsia

The answer is C. 0.45% Normal saline is a hypotonic solution. It can be used to treat hypernatremia (lower the sodium levels in the blood). This fluid causes osmosis to move water from the extracellular space to the intracellular space. If too much is moved to the intracellular space cell swelling can present. Signs of this include mental status changes like confusion. Therefore, the nurse would want to hold the fluid and notify the doctor for further orders. Polydipsia is excessive thirst which presents with hypernatremia. Increase urination and a decreasing sodium level are expected with IV fluid administration.

Which fluid type is MOST likely to cause hypernatremia along with fluid volume overload and requires close monitoring by the nurse during administration? A. 0.45% Normal Saline B. Dextrose 5% in water C. 3% Saline D. 0.225% Saline

The answer is C. 3% Saline is a hypertonic solution and contains a concentrated amount of the sodium. It will cause fluid to leave the intracellular space and enter the extracellular space. This could lead to fluid volume overload and requires very close monitoring by the nurse. The other solutions listed here are hypotonic.

Which patient below is at risk for fluid volume overload while receive 0.9% Normal Saline? A. A patient with hyponatremia. B. A patient experiencing dehydration. C. A patient with heart failure. D. A patient who is vomiting.

The answer is C. In cases of the heart failure, the heart is too weak to pump fluid out of the heart. This can lead the body to become overwhelmed with fluid. Patients who are experiencing heart or kidney failure are at risk for fluid volume overload when receiving fluids.

What type of fluid volume overload presents with no drastic shifting of water from the compartments because osmolarity is equal but overloads the extracellular compartment? A. Hypertonic overload B. Hypotonic overload C. Isotonic overload

The answer is C. Isotonic overload presents with no drastic shifting of water from the compartments because osmolarity is equal but overloads the extracellular compartment. This can happen from heart or kidney failure, too much isotonic IV fluids, and over usage of Corticosteroids (which cause the body to retain sodium and water).

Which statement below is the most accurate about the process of osmosis? A. Water will moves from a solution with a higher solute concentration to a solution with a lower solute concentration. B. Water and solutes will move from a lower water concentration solution to a higher water concentration solution. C. Water will move from a lower solute concentration solution to a higher solute concentration solution. D. Water will move from a fluid of a lower water concentration to a fluid of a higher water concentration.

The answer is C. Osmosis is the movement of water from a fluid of higher water concentration to a fluid of lower water concentration, or, in other words, water will move from a lower solute concentration fluid to a higher solute concentration fluid.

What is the fluid compartment that is found inside the blood vessels? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is C: intravascular compartment

Your patient is experiencing a severe gastrointestinal bleed. What type of fluid volume deficit will this patient experience? A. Hypertonic dehydration B. Hypotonic dehydration C. Isotonic dehydration

The answer is C: isotonic dehydration. This type of fluid volume deficit occurs when there is an EQUAL loss of water and electrolytes. This is the most common type of fluid volume deficit seen, and the problem from this type of dehydration arises from the intravascular loss (which can lead to hypovolemic shock).

What type of fluid below has a low osmolarity? A. 0.9% Normal Saline B. 3% Saline C. Dextrose 5% in 0.9% Normal Saline D. 0.45% Normal Saline

The answer is D. 0.45% Normal Saline is a hypotonic solution. It contains a lower concentration on solutes compared to the blood plasma. Due to this, it will cause water to move from the extracellular space to the intracellular space, which could swell the cell leading to possible rupture.

What is the only fluid type that can be administered with blood products? A. Lactated Ringer's solution B. 0.45% Normal Saline C. 3% Saline D. 0.9% Normal Saline

The answer is D. 0.9% Normal Saline is the ONLY fluid that can be administered with blood products.

Your patient who is receiving treatment for fluid volume overload has lost 2 lbs. since receiving treatment. Based on the patient's weight loss, about how much fluid has the patient lost? A. 2 liters B. 6 liters C. 4 liters D. 1 liter

The answer is D: 1 liter. A general rule to remember is that 1 kg (2.2 lbs) is equal to about 1 liter of fluid. Therefore, if the patient has lost 2 lbs., the patient has lost around 1 liter of fluid.

Which fluid below is NOT categorized as an isotonic fluid? A. 0.9% Normal Saline B. Lactated Ringer's solution (LR) C. Dextrose 5% in water D. Dextrose 5% in 0.45% Normal Saline

The answer is D: Dextrose 5% in 0.45% Normal Saline This is a hypertonic solution. Dextrose 5% in water is considered isotonic but once administered it become hypotonic (it categorized as an isotonic fluid).

A patient is experiencing hypertonic overload. What could cause this type of overload? A. Corticosteroids over usage B. Primary polydipsia C. SIADH D. Excessive sodium intake

The answer is D: excessive sodium intake. This will cause an increase of sodium concentration in the blood (plasma), which will increase osmolarity and cause hypertonic overload.

Which fluid compartment accounts for 2/3 of our body water and is found inside the cell? A. Transcellular B. Interstitial C. Intravascular D. Intracellular

The answer is D: intracellular. The intracellular compartment accounts for 2/3 of our body water and is found inside the cell.

What is the fluid compartment that is found in certain body cavities like the spinal cavity, heart, lungs, and joints? A. intracellular compartment B. interstitial compartment C. intravascular compartment D. transcellular compartment

The answer is D: transcellular compartment

True or False: Lactated Ringer's Solution is first-line treatment for fluid resuscitation situations. True False

The answer is FALSE. LR contains glucose which can increase the blood glucose and is not first-line treatment for fluid resuscitations situations.

True or False: Osmosis is an active transport process. True False

The answer is FALSE. Osmosis is a passive type of transport process.

True or False: If a solution has a high concentration of solutes, it is considered to have a high osmolarity. True False

The answer is TRUE.

True or False: The extracellular compartment includes the intravascular, interstitial, and transcellular compartments.

The answer is True.

True or False: Most of the fluid in the body is found in the intracellular space.

The answer is true. The intracellular space is the space inside of the cell. The fluid in it accounts for 2/3 of our body water. Therefore, most of our fluid is inside the cell.

A patient is receiving treatment for fluid volume deficit (hypertonic dehydration). What will the nurse implement in the patient's plan of care? Select all that apply: A. Daily weights B. Administer hypotonic IV solutions per physician's order C. Increase sodium intake D. Monitor sodium level E. Encourage the patient to limit fluids to 1-2 liters per day F. Strict intake and output measurements

The answers are A, B, D, and F. The nurse would want to weigh the patient daily (this is a great early indicator of the patient's fluid status). Administer hypotonic IV solutions per physician's order to help rehydrate the cell and fluid compartments. Monitor sodium level because it can become too high in this type of dehydration. However, when the nurse administers hypotonic IV solutions the sodium level should be monitored to ensure it doesn't get too low (hyponatremia) because the hypotonic solution could dilute fluid quickly, if not monitored closely. Limiting fluids should be avoided (1-2 L/day is a low amount of fluid per day and would be initiated in fluid volume OVERLOAD). Finally, the nurse would strictly monitor intake and output to ensure the patient is receiving enough fluid and urinary output is within normal range (30 mL/hr or 0.5 mL/kg/hr).

What signs and symptoms could present with fluid volume deficit in an adult patient? Select all that apply: A. Weight loss B. Pitting edema C. Confusion D. Rales E. Thirst F. Orthostatic hypotension G. Weak pulse H. Increase skin turgor

The answers are A, C, E, F, and G. Weight loss, confusion, thirst, orthostatic hypotension, and weak pulse all can present in an adults with fluid volume deficit.

Select all the fluid spaces that make up the extracellular compartment: A. transcellular B. extravascular C. intravascular (plasma) D. interstitial

The answers are A, C, and D. The interstitial, intravascular, and transcellular fluid compartments make up the extracellular compartment.

You assess the lab report for your patient who has isotonic fluid volume overload. Which lab results below are expected with this condition? Select all that apply: A. Decreased hemoglobin B. Increased sodium level C. Decreased urine specific gravity D. Increased BUN E. Decreased serum osmolality

The answers are A, C, and E. Remember when fluid volume overload is presenting there is going to be a lot of fluid in the blood and urine. This will make the blood and urine less concentrated (diluted). Therefore, concentration of certain substances in the blood will be decreased. The patient can have: decrease in hemoglobin, hematocrit, decrease in sodium, decreased urine specific gravity and osmolality, and decreased serum osmolality.

Select all the signs and symptoms below that could present with fluid overload: A. Weight gain B. >3 seconds capillary refill C. Orthostatic hypotension D. Frothy, bloody tinged cough E. Ascites F. Jugular venous distention G. Weak pulse H. Rales

The answers are A, D, E, F, and H. All of these are possible signs and symptoms of fluid volume overload. Option B, C, and G are signs found in fluid volume deficit.

Your patient has a diagnosis of fluid volume overload (isotonic). Select all the interventions you plan to implement for this patient: A. Encourage patient to limit fluid intake to 4 Liters per day B. Strict monitoring of intake and output C. Weigh patient daily at the same time with the same scale D. Administer diuretics per physician's order E. Ensure urinary output is at least 10 mL/hr or greater F. Restrict foods high in sodium

The answers are B, C, D, and F. Option A is not correct because 4 L/day is a high amount of fluid, and the patient should be on a fluid restriction of about 1-2 L/day. Option E is not correct because the nurse should ensure the urinary output is at least 30 mL/hr (0.5mL/kg/day). A urinary output of >10 mL/hr is too low and not an appropriate goal for the patient.

A patient is admitted with fluid volume deficit (isotonic dehydration). What lab results would the nurse expect to see in this patient? Select all that apply: A. Decreased hemoglobin B. Increased serum osmolality C. Increased urine specific gravity D. Decreased urine osmolality E. Increased BUN

The answers are B, C, and E. Lab results are going to depend on the type of dehydration, but in most cases there will be a low amount of fluid in the blood and urine. Therefore, the blood and urine are going to be concentrated. As a result, the tests that check for blood and urine concentrations will be INCREASED: serum osmolality, hemoglobin, hematocrit, BUN, sodium level, urine specific gravity and osmolality.

What signs and symptoms in a young infant would alert the nurse that the patient is likely experiencing fluid volume deficit? Select all that apply: A. Weight gain B. Bulging fontanelles C. Sunken fontanelles D. No tears when crying

The answers are C and D. Sunken fontanelles (the spaces in between the skull bones that present as soft spots on the head during the first part of life) and no tears when crying would alert the nurse the infant is dehydrated. In addition, the infant may be fussy, restless, and experience weight loss.

What signs and symptoms of fluid volume deficit are not likely to present in older adults (geriatric patient populations)? Select all that apply: A. Sluggish capillary refill B. Confusion C. Thirst D. Weight loss E. Decreased skin turgor

The answers are C and E. As people age the thirst response decreases along with skin elasticity. Therefore, thirst and decreased skin turgor are not reliable signs and symptoms of fluid volume deficit in the geriatric population.

air embolism

air traveling into vascular system

intravascular fluid

blood plasma

pulmonary embolus

clot traveled to lungs

hypotonic iv solutions

contains fewer dissolved substances than normally found in plasma

Isotonic IV solutions

contains the same concentration of dissolved substances as normally found in plasma

How to reduce fluid volume

treating the disorder contributing to the increased fluid volume, restrict or limit oral fluids, reduce salt consumption, discontinue IV fluid infusions, administer drugs that promote urine elimination, using a combination of the above interventions.

how often is solution changed/replaced

when finished or 24 hours whichever occurs first