Fluids

Question 1

What are the 3 categories of solutions by osmolarity? What osmolality (the concentration of particles found in blood) do they have?

Answer 1

1. Isotonic –> used to expand extracellular fluid. There’s not much shifting happening
   - Used to replace (extra cellular) fluid loss & treat dehydration!!
   - same OSMOLALITY as ECF
2. Hypotonic –> used to shift fluid into interstitial space and into cells.
   - Swell the cell, OSMOLALITY is less than ECF
   - Used to treat cellulars dehydration or if sodium is too high
3. Hypertonic –> used to shift extracellular fluid into plasma. more fluid in the extracellular fluid than in the cell.
   - Shrink the cell, OSMOLALITY is greater than ECF
   - causes pulmonary edema

Question 2

What are the prevention of catheter-related blood stream infection??

Answer 2

1. Hand hygiene/ IV team/ adequate staffing
2. Site of catheter insertion - best is ventral line
3. Max. sterile barrier precautions during insertion
4. Skin asepsis
5. Daily review of line necessity

Question 3

What do you need to know about TPN? (when is it used?

Answer 3

1. Used for pt. unable to absorb nutrient (unable to digest/absorb enteral feedings): like large burn or trauma, cancer
2. It contains glucose/dextrose 10-30% (isotonic is 5%)
3. It’s a HYPERTONIC solution that contains glucose, amino acids(proteins), electrolytes, fat emulsions (lipids)
4. Insulin may be needed due to high concentration of glucose in the solution
5. You can give fat emulsions “piggyback”
6. CENTRAL VEIN IS REQUIRED

Question 4

What are the TPN care you need to monitor for someone with TPN?

Answer 4

1. USES Central line (!!) and is very HYPERtonic and must be diluted in large area of blood.
2. Need chest X-RAY after it is inside !!!
3. Need time to adjust to high glucose:
   - Wean on and off over 1-2 days
   - Check blood glucose every 6 HOURS, give insulin on a sliding scale if needed
4. Prevent sepsis
   - Strict aseptic care (sterile technique) of equipment & site
   - Change complete IV tubing and filter WITH A NEW BAG EVERY 24 HOURS!!
5. IV site monitored every 2 hours!
6. USE IV pump!

Question 5

What are the 5 IV therapy complications, findings, and the nursing interventions!!

Answer 5

1. Circulatory overload
   - Findings: Edema, crackles, shortness of breath
   - NI: Reduce IV rate, notify HCP, Raise HOB, Monitor VS and labs
2. Infiltration (fluid into tissue)
   - Findings: Skin cool to touch and skin taunt
   - NI: Stop infusion/ DC IV/ Start new line. Elevate extremity, Apply warm or cold compress
3. Phlebitis (inflammation of vein)
   - Findings: redness, tenderness, pain, warmth along vein
   - NI: Stop infusion, start new line, apply warm compress, contact HCP if needed, do not rub or massage area!!!!!!
4. Local infection
   - Redness, heat, swelling, possible drainage
   - NI: Culture drainage, remove IV/ start a new IV, Notify HCP
5. Bleeding
   - Findings: fresh blood may be pooling
   - NI: Assess if IV intact, apply pressure, start new line if needed

Question 6

What are the 7 IV therapy key points??

Answer 6

1. Periphreal IV tubing changed every 72 hours
2. IV site monitored every 2 hours!
3. IV solution bag changed every 24 hours
4. Make sure IV pump set right
5. IV pump/respond to the alarms
6. SCRUB THE HUB
7. Maintain integrity of the system (if tip falls of or touched the patient/bed, re-change it)

Question 7

What are the nursing delegation for IV therapy??

Answer 7

1. IV therapy cannot be delegated to a UAP. delegation to LPN depends on each state
2. UAPs should report any patient complaints regarding the IV, dressing becomes loose, IV pump alarm signals, and IV bag is almost empty
3. Any changes in patient’s temp.

Question 8

What are the S/S of Hypovolemia (fluid volume deficit or dehydration)?? (causes, labs and assessment)

Answer 8

• Causes: GI losses, sweating, hemorrhage, insufficient intake, Third spacing
• Labs: Hct (hematocrit), Na+, BUN, Urine specific gravity, Blood osmolarity
• Assessment: Wt loss, Oliguria, Thirst, Dry mucus membranes, Tachycardia, Weak pulse, Hypotension, Loss of skin turgor!!!

Question 9

What are the S/S of Hypervolemia (fluid volume deficit- OVERLOAD)?? (causes, labs and assessment)

Answer 9

• Causes: retention of Na+ and H20, Cirrhosis, CHF, excessive IV fluids or ingestion of salt, Kidney disease
• Labs: Hct (hematocrit), Na+, BUN, Urine specific gravity, Blood osmolarity
• Assessment: Bounding pulse, HTN* (the hypertension can result in hypotension), Tachycardia, crackles, SOB/shortness of breath, Edema, Wt gain

Question 10

What is diffusion?
What is active transport?

What is filtration?

Answer 10

• Diffusion is going from High to Low concentration. occurs automatically/ passive process.
• Active Transport moves from Low to High concentration. it uses ATP like Sodium-potassium pump.
• Filtration is movement of an area from high to low pressure

Question 11

What is osmosis?

Answer 11

Movement of WATER from LOW to HIGH; a passive process. This is how Physician determine what solution of the IV fluid a patient needs. “Are we trying to pull the fluid out of the cell, or are we trying to pull it into the cell?”

Question 12

What is Hydrostatic Pressure and Osmotic/Oncotic pressure???????!! Why is albumin important in Osmotic pressure???

Answer 12

This is how we do arterial and venous ends exchanges!

• Hydrostatic pressure is the force created by fluid.
  Basically blood brings nutrients to the cells right?? So how does this happen? Hydrostatic pressure is what forces fluid thru the capillary bed. Once the hydrostatic pressure inside the capillary is GREATER than the pressure in the surrounding interstitial space, fluids are forced OUT.
• Osmotic/ Oncotic pressure is power of a solution to draw water. ALBUMIN maintain this!!! ALBUMIN IS IMPORTANT here because it’s the “water-magnet” and attracts/holds water inside that blood vessels!!

1. Arterial end = Once hydrostatic pressure is HIGHER than oncotic pressure, it’s going to push the fluids out of the capillary.
2. Venous end = How the waste product from the cells are pushed to the capillary bed so tht it can be carried away to the lungs. Once Oncotic pressure is HIGHER than hydrostatic pressure, fluids are pulled back into the capillaries.

Question 13

What is the role of albumin in Third spacing

Answer 13

• Osmotic/ Oncotic pressure is the power of a solution to draw water. ALBUMIN maintain this!!! ALBUMIN IS IMPORTANT here because it’s the “water-magnet” and attracts/holds water inside that blood vessels!!
• So, If ALBUMIN IS LOW = Decreased Oncotic pressure of the blood which causes a failure to pull/withdraw that fluid back to the capillary (venous end) and can cause Third spacing. EX–> pulmonary edema, ascites, burns
• Since not a lot of fluid goes back to the capillary, there’s going to be a Decreased BP, Increased HR,

Question 14

What is Third spacing?

Answer 14

Fluid trapped where it is not as available to circulate. It occurs when there is a change in Hydrostatic and oncotic pressure like injury, inflammation, malnutrition or liver issues, vascular fluid overload.
- EX: ascites (stomach “bloating”), pulmonary edema, burns

Question 15

Site of IV catheter to prevent catheter-related blood stream infection is where?

Answer 15

The central line!