Fund Week 7 Ppt

Front 1

More fat/obese results in

Back 1

Less water in ICF and ECF

Front 2

What fraction of water makes up ECF

Back 2

1/3

Front 3

What fraction of water makes up ICF

Back 3

2/3

Front 4

What are the three parts of the ECF

Back 4

Intravascular: the liquid part of blood (plasma)

Interstitial: Located between the cells and outside the blood vessels

Transcellular fluid: Example is cerebrospinal fluid (CSF)

Front 5

More dilute than blood is

Back 5

Hypotonic solution

Front 6

More concentrated than blood is

Back 6

Hypertonic solution

Front 7

True or false: In certain parts of the body there are higher rates of a specific electrolyte because it is needed more in that place to carry out its specific function

Back 7

True

Front 8

Filtration

Back 8

Want to use to create a fluid balance in through the use of IV also

Front 9

True or false: Blood contains albumin and other proteins called colloids

Back 9

True

Front 10

Cause of edema relluated to pressure

Back 10

The body is not effectively bringing those pressures back to a balance.

Front 11

Water is important because it is a primary source of the body because

Back 11

Transports nutrients

Bringing wastes in and out of cell

Regulates temperature(sweat/evaporate)

Tells how much muscle weight vs fat

Front 12

True or False: Thirst will impact fluid intake

Back 12

True

Front 13

The average daily intake of a healthy adult person

Back 13

2300ml

Front 14

Antidiuretic hornone (ADH)

Back 14

Made by neurons in the hypothalamus released from posterior pituitary gland

Front 15

What does too much ADH result in?

Back 15

Less urine excreted

Front 16

What is the result of having too little ADH?

Back 16

More urine excreted

Front 17

Which system indicated an indication of retention for the amount of sodium to water and cause a change in blood pressure

Back 17

Renin Angiotensin Aldosterone System (RAAS)

Front 18

When is Atrial Natriuretic Peptide (ANP) released?

Back 18

Released when increased Extracellular fluid to influence sodium/ water excretion

Front 19

Major factor of Osmolality imbalance

Back 19

Osmotic shift of water

(Ex:) Isotonic fluid

Front 20

Osmolality imbalance deficit

Back 20

Not enough Isotonic fluid

SS: Hypovolemia

Front 21

Osmolarity imbalance excessive

Back 21

Excessive is ironic fluid

Hypervolemia - high volume of something

Front 22

Hypernatremia

Back 22

Water deficit

Front 23

Hyponatremia

Back 23

Water excess

Front 24

Dehydration

Back 24

A combination of vascular volume and water deficit

Front 25

Low and high potassium results in

Back 25

Muscle weakness and can be life threatening

Front 26

True or False

Back 26

True

Front 27

High Calcium results in

Back 27

Muscle twitching

Front 28

Low Magnesium results in

Back 28

Lethargy

Front 29

True or false: Changes in the Extracellular fluid causes changes in the RAAS to maintain balance.

Back 29

True

Front 30

High Magnesium results in

Back 30

G

Front 31

Where are the cells of the Atrial Natriuretic Peptide (ANP) located

Back 31

Located in the atria of the heart

Front 32

ANP

Back 32

Can see heart and it’s ability of pumping, its ability to excrete sodium and water

Front 33

Osmolality

Back 33

Fluid inside the body (solute concentration in fluid by weight or the number of millimols in a kilogram of solution)

Front 34

Osmolarity

Back 34

Solute concentration in fluid by millimols per liter

Front 35

Osmolarity is fluid by ______ per _____

Back 35

Millimols per liter

Front 36

Osmolality is fluid by ______ per _____

Back 36

Millimols per kg

Front 37

True or False

Back 37

True

Front 38

True or False: Although there might be the same volume the changes in the level of solute concentration influences the movement of water in/out of components

Back 38

True

Front 39

Potassium, Calcium, and Magnesium are all low in

Back 39

Plasma concentration

Front 40

Potassium, Calcium, and Magnesium are found mostly in

Back 40

cells and bones that are necessary for the normal muscle and nerve function.

Front 41

Acid excretion in IV must match

Back 41

the same amount produced

Front 42

Factors in determining the acidity of blood

Back 42

Hydrogen ions and add pH

Front 43

Normal arterial blood that is optimal for cell function is

Back 43

7.35 - 7.45

Front 44

What are the 4 types of imbalances?

Back 44

Respiratory acidosis

Respiratory Alkalosis

Metabolic Alkalosis

Metabolic Acidosis

Front 45

Kidneys excrete all acids except

Back 45

Carbon and Metabolic (bi carb) acid

Front 46

Reference

Back 46

;)

Front 47

Patient history

Back 47

Age

Gender

Body composition- environment, exercise, diet (a lot of salt? Foods rich in electrolyte, medications, surgeries/injuries

Front 48

Acid excretion in IV must match

Back 48

the same amount produced

Front 49

Factors in determining the acidity of blood

Back 49

Hydrogen ions and add pH

Front 50

Normal arterial blood that is optimal for cell function is

Back 50

7.35 - 7.45

Front 51

What are the 4 types of imbalances?

Back 51

Respiratory acidosis

Respiratory Alkalosis

Metabolic Alkalosis

Metabolic Acidosis

Front 52

Kidneys excrete all acids except

Back 52

Carbon and Metabolic (bi carb) acid

Front 53

Reference

Back 53

;)

Front 54

Patient history

Back 54

Age

Gender

Body composition- environment, exercise, diet (a lot of salt? Foods rich in electrolyte, medications, surgeries/injuries

Front 55

Also ask i in Patient is there anything that would

Back 55

Impair secretion, increase secretion, or loss of fluid

Front 56

Acid excretion in IV must match

Back 56

the same amount produced

Front 57

Health promotion is also a part of

Back 57

Implementation

Front 58

Implementation: Health promotion includes

Back 58

Diet education , Health information, etc (table 42.4)

Front 59

Factors in determining the acidity of blood

Back 59

Hydrogen ions and add pH

Front 60

Normal arterial blood that is optimal for cell function is

Back 60

7.35 - 7.45

Front 61

Reference

Back 61

;)

Front 62

Kidneys excrete all acids except

Back 62

Carbon and Metabolic (bi carb) acid

Front 63

Reference

Back 63

;)

Front 64

Patient history

Back 64

Age

Gender

Body composition- environment, exercise, diet (a lot of salt? Foods rich in electrolyte, medications, surgeries/injuries

Front 65

Front (Term)

Back 65

Where the mouse is the upper and lower number have such a huge difference in blood. “ There was not a high number when you draw blood from the vein)

Front 66

Physical Assessment (

Back 66

Vital signs

*I/O measurements (taken when person is receiving fluid intake)

Respiratory status

Cardiovascular status

Neurological status

GI/GU status

Front 67

Front (Term)

Back 67

Where the mouse is the upper and lower number have such a huge difference in blood. “ There was not a high number when you draw blood from the vein)

Front 68

Acid excretion in IV must match

Back 68

the same amount produced

Front 69

Health promotion is also a part of

Back 69

Implementation

Front 70

Implementation: Health promotion includes

Back 70

Diet education , Health information, etc (table 42.4)

Front 71

Enteral fluid replacements

Back 71

Are oral replacements of F&E or restrictions

Front 72

Factors in determining the acidity of blood

Back 72

Hydrogen ions and add pH

Front 73

Reference

Back 73

;)

Front 74

What are the 4 types of imbalances?

Back 74

Respiratory acidosis

Respiratory Alkalosis

Metabolic Alkalosis

Metabolic Acidosis

Front 75

Kidneys excrete all acids except

Back 75

Carbon and Metabolic (bi carb) acid

Front 76

Reference

Back 76

;)

Front 77

Front (Term)

Back 77

Where the mouse is the upper and lower number have such a huge difference in blood. “ There was not a high number when you draw blood from the vein)

Front 78

Also ask i in Patient is there anything that would

Back 78

Impair secretion, increase secretion, or loss of fluid

Front 79

Physical Assessment (

Back 79

Vital signs

*I/O measurements (taken when person is receiving fluid intake)

Respiratory status

Cardiovascular status

Neurological status

GI/GU status

Front 80

Enteral fluid replacements

Back 80

Are oral replacements of F&E or restrictions/witholding

Front 81

Which fluid reinforces total intake with patient and family

Back 81

External fluid replacements

Front 82

Parenteral replacements

Back 82

Through a voxicular oxygenative device

Front 83

Which fluid reinforces total intake with patient and family

Back 83

External fluid replacements

Front 84

Parenteral replacements

Back 84

Through a voxicular oxygenative device

Front 85

G

Back 85

F

Front 86

Parenteral replacements

Back 86

Vascular access device equipment Starting IV (intravenous line)

Front 87

IV s

Back 87

Can quickly make fluid shifts happen quickly

Front 88

What are the two different types of of fluid replacements

Back 88

1 Colloids/blood

2 Crystalloid

And they travel quickly through the membrane (no trouble getting in)

Front 89

3 types of Osotonic

Back 89

G

Front 90

3 types of Osotonic

Back 90

G

Front 91

3 types of Osotonic

Back 91

G

Front 92

3 types of Osotonic

Back 92

G

Front 93

3 types of Osotonic

Back 93

G

Front 94

3 types of Osotonic

Back 94

G

Front 95

3 types of Osotonic

Back 95

G

Front 96

3 types of Osotonic

Back 96

G

Front 97

3 types of Osotonic

Back 97

G

Front 98

3 types of Osotonic

Back 98

G

Front 99

3 types of Osotonic

Back 99

G

Front 100

3 types of Osotonic

Back 100

G

Front 101

3 types of Osotonic

Back 101

G

Front 102

Problem with Lactated Ringers

Back 102

It gets metabolized by the liver and converts this lactate into bicarb

Front 103

True or False: Give lactated Ringers solution to patient with kidney problems who has a very Alkalotic pH

Back 103

False, Lactated Ringers should not be given to a patient with kidney problems who has a very Alkalotic pH because it will increase the amount of bicarbonate making the person more alkalotic

Front 104

Ringers solution

Back 104

Is similar to Lactated Ringers except

There is no Lactate

And it does not cause alkalization ppl

Front 105

What kind of solution is the D5W

Back 105

Isotonic

Front 106

True or false: DS5 is initially isotonic but when eneterinf the body it metabolizes and becomes a Hypotonic solution

Back 106

True

Front 107

Free water: _______

Back 107

Hypotonic

Front 108

When will the health care provider see free water (water passes through membrane to ICF and ECF spaces in a patient?

Back 108

When the patient has high sodium level since water will normalize this sodium level

Front 109

True or false: D5W cannot be used to treat lack of volume because this patient needs a lot of volume and that’s not what D5W is used for

Back 109

True

Front 110

H

Back 110

H

Front 111

True or False: D5W is not good for any low BP, hemorrhaging circulatory/vascular collapse because it is does not stay Isotonic

Seen early post op

Back 111

True

Front 112

What are two examples of colloids?

Back 112

Blood

Proteins

Front 113

C

Back 113

F

Front 114

True or false Worry about any place where I am concerned about intracranial pressure

Back 114

True

Front 115

In Neuro patient I am concerned about Using D5W because it becomes when it becomes hypotonic and it renters the cell it can renter the tissues and makes grain swelling occur. The neuro patient already has a higher pressure in the brain

Back 115

R

Front 116

Intracellular

Intravascular

Inter spatial shifts

Are needed when

Back 116

We’re trying to hydrate those cells

Front 117

Types of hypotonic solution

Back 117

0.45% sodium chloride

0.2% NaCl

2.5% Dextrose in water

Front 118

Hypertonic solutions

Back 118

When you want to take water out of the cell and increase the ECF volume

Front 119

Adding more than 5% dextrose would be considered a _______ solution

Back 119

Hypertonic

Front 120

Hypertonic solution would be used for someone who is

Back 120

Hypoglycemic because I need to correct it quickly

Front 121

Hypertonic solution is not used for

Back 121

Concern of someone with volume overload

Ex: pulmonary edema,

Depending on how high the amount of solution is given would need to change peripheral IV because it may be too caustic to the vessels

Front 122

G

Back 122

H

Front 123

Colloids

Back 123

Contain large molecules that do not pass through semipermeable membranes.

They remain in the intravascular compartment and expand its volume by drawing fluid from the extra vascular spaces.

Front 124

Potassium is important because it influences how your _____ and _____ work

Back 124

Muscles and heart

And is frequently being balanced in hospital because it is important

Front 125

Potassium chloride (KCL)

Back 125

Is a common additive to IV solutions and NEVER is administered through IV push

The solution must be diluted

Front 126

IV Push

Back 126

Injected directly into an IV

Front 127

V

Back 127

I

Front 128

True or false: The amount of potassium given will depend on how much volume, how fast, and if it is vital that they get a significant amount in over a certain period of time. May also need to choose a central access or catheter that is going into a central access like the superior vena cava.

Back 128

True

Front 129

True or false: Very often I will see medications, fluid replacements, blood administration, and more dilute slower administration of potassium that is mixed into IV fluids and given peripherally

Back 129

True

Front 130

Central catheters for to the

Back 130

Central vein

Front 131

True or False: Peripherally inserted central catheters (PICC) tend to last a little bit longer than the direct central catheters

Back 131

True

Front 132

Hospitals are very aware of CLABSI which are

Back 132

Central line associated blood stream infections and therefore typically do not like to have any central access if they don’t have to

Front 133

True or false: When giving IV start more distal and work more proximally across the hand

Back 133

True

Front 134

Crystalloids

Back 134

These are solutes (electrolytes or non-electrolytes) capable of crystallization and are easily mixed and dissolved in a solution.

They are small and able to easily flow across semipermeable membranes

Crystalloids allow for transfer from the bloodstream into the cells and the body tissue.

Front 135

Fluid resuscitation foR low ECF If worried about low ECF use

Back 135

Use normal saline 0.9%

Front 136

Low ECF symptoms

Back 136

Hemorrhage

Sever vomiting or diarrhea

Excessive drainage for GI secretions

Front 137

Low ECF contributions to conditions

Back 137

Shock

Mild hyponatremia

Metabolic acidosis

Hypercalcemia

Front 138

What is the only fluid to be used with administration of blood products

Back 138

0.9 Normal saline is the only

Front 139

Lactated Ringer’s

Back 139

Used in situation where patient has significant burn. Tho it is the only thing is closest to our own make up of everything that is the plasma and the blood

Front 140

True or false: When giving IV start more distal and work more proximally across the hand

Back 140

True

Front 141

3 types of Osotonic

Back 141

G

Front 142

Problem with Lactated Ringers

Back 142

It gets metabolized by the liver and converts this lactate into bicarb

Front 143

True or False: Give lactated Ringers solution to patient with kidney problems who has a very Alkalotic pH

Back 143

False, Lactated Ringers should not be given to a patient with kidney problems who has a very Alkalotic pH because it will increase the amount of bicarbonate making the person more alkalotic

Front 144

Ringers solution

Back 144

Is similar to Lactated Ringers except

There is no Lactate

And it does not cause alkalization ppl

Front 145

What kind of solution is the D5W

Back 145

Isotonic

Front 146

True or false: DS5 is initially isotonic but when eneterinf the body it metabolizes and becomes a Hypotonic solution

Back 146

True

Front 147

Free water: _______

Back 147

Hypotonic

Front 148

When will the health care provider see free water (water passes through membrane to ICF and ECF spaces in a patient?

Back 148

When the patient has high sodium level since water will normalize this sodium level

Front 149

True or false: D5W cannot be used to treat lack of volume because this patient needs a lot of volume and that’s not what D5W is used for

Back 149

True

Front 150

H

Back 150

H

Front 151

True or False: D5W is not good for any low BP, hemorrhaging circulatory/vascular collapse because it is does not stay Isotonic

Seen early post op

Back 151

True

Front 152

What are two examples of colloids?

Back 152

Blood

Proteins

Front 153

C

Back 153

F

Front 154

True or false Worry about any place where I am concerned about intracranial pressure

Back 154

True

Front 155

In Neuro patient I am concerned about Using D5W because it becomes when it becomes hypotonic and it renters the cell it can renter the tissues and makes grain swelling occur. The neuro patient already has a higher pressure in the brain

Back 155

R

Front 156

Intracellular

Intravascular

Inter spatial shifts

Are needed when

Back 156

We’re trying to hydrate those cells

Front 157

Types of hypotonic solution

Back 157

0.45% sodium chloride

0.2% NaCl

2.5% Dextrose in water

Front 158

Hypertonic solutions

Back 158

When you want to take water out of the cell and increase the ECF volume

Front 159

Adding more than 5% dextrose would be considered a _______ solution

Back 159

Hypertonic

Front 160

Hypertonic solution would be used for someone who is

Back 160

Hypoglycemic because I need to correct it quickly

Front 161

Hypertonic solution is not used for

Back 161

Concern of someone with volume overload

Ex: pulmonary edema,

Depending on how high the amount of solution is given would need to change peripheral IV because it may be too caustic to the vessels

Front 162

G

Back 162

H

Front 163

Colloids

Back 163

Contain large molecules that do not pass through semipermeable membranes.

They remain in the intravascular compartment and expand its volume by drawing fluid from the extra vascular spaces.

Front 164

Potassium is important because it influences how your _____ and _____ work

Back 164

Muscles and heart

And is frequently being balanced in hospital because it is important

Front 165

Potassium chloride (KCL)

Back 165

Is a common additive to IV solutions and NEVER is administered through IV push

The solution must be diluted

Front 166

IV Push

Back 166

Injected directly into an IV

Front 167

V

Back 167

I

Front 168

True or false: The amount of potassium given will depend on how much volume, how fast, and if it is vital that they get a significant amount in over a certain period of time. May also need to choose a central access or catheter that is going into a central access like the superior vena cava.

Back 168

True

Front 169

True or false: Very often I will see medications, fluid replacements, blood administration, and more dilute slower administration of potassium that is mixed into IV fluids and given peripherally

Back 169

True

Front 170

Central catheters for to the

Back 170

Central vein

Front 171

True or False: Peripherally inserted central catheters (PICC) tend to last a little bit longer than the direct central catheters

Back 171

True

Front 172

Hospitals are very aware of CLABSI which are

Back 172

Central line associated blood stream infections and therefore typically do not like to have any central access if they don’t have to

Front 173

True or false: When giving IV start more distal and work more proximally across the hand

Back 173

True

Front 174

Crystalloids

Back 174

These are solutes (electrolytes or non-electrolytes) capable of crystallization and are easily mixed and dissolved in a solution.

They are small and able to easily flow across semipermeable membranes

Crystalloids allow for transfer from the bloodstream into the cells and the body tissue.

Front 175

C

Back 175

G

Front 176

Fluid resuscitation foR low ECF If worried about low ECF use

Back 176

Use normal saline 0.9%

Front 177

Low ECF symptoms

Back 177

Hemorrhage

Sever vomiting or diarrhea

Excessive drainage for GI secretions

Front 178

Low ECF contributions to conditions

Back 178

Shock

Mild hyponatremia

Metabolic acidosis

Hypercalcemia

Front 179

What is the only fluid to be used with administration of blood products

Back 179

0.9 Normal saline is the only

Front 180

True or false: When giving IV start more distal and work more proximally across the hand

Back 180

True, this avoids any medication leaking out or any limitation for medication to beyond the area of infiltration and have the tissue bleed.

Front 181

Hypovolemic AKA

Back 181

AKA “from 3rd spacing”; a loss of Extracellular fluid (ECF) from the vascular to other body compartments.

Front 182

Giving Intravenous catheters (general)

Back 182

Need to have an order

Know the (5) rights: right order, patient, time, route, medication

Explain procedure

Supplies: Turnequette

1. Decide where I am going to put the vein

2. Put turnequette on and see if I can palpate a vein

3. Clean the area

4. Determine what size IV needle (lumen)

Giving Med or blood = size 20

Size 22 = small catheter for adult

IIC - Intermittent infusion cap

Hep (heparin) lock/cap

IIC and Hep lock mean that I am putting a catheter in the vein with a tube with a connector for that is finally taped. Only used to give fluid or medication through it. (There’s nothing that’s going to be hanging on it/in addition to it (medications or fluids)

Need to have syringe with normal saline setup prior to inserting it

5. Insert beveled up (not attached to the patient)

6. Flush normal saline into the line to make sure that I have primed the line. Do not want any air in the line

7. Clean the area

Hold the skin and with my dominant hand inserting at 15 degrees until I see a draw back of a flash of blood. This lets me know that I am in the vein, therefore, I don’t need to angle anymore.

8. Then I would go more parallel on the vein

9. Push and advance the father ahead so that the catheter only goes in and what is left is the blue color because the needle is all the way under the skin.

10 Use the safety lock and withdraw/remove

11 put catheter on in the same place

12 remove tourniquet (blue elastic band)

13 unclamp roller (white little thing)

14 Flush the line and see that it is able to flush the blood in easily and doesn’t hurt the patient

15 Secure it with a translucent dressing and then tape it down

16 If it’s going to have IV in place, insert it and then tape it down

Front 183

How to Clean area for IV site

Back 183

Horizontally

Vertically

Then circularly

Let it dry

Front 184

Many ways that an IV site can become contaminated

Back 184

Back (Definition)

Front 185

IV fluid one

Important to get right solution

2 Look at the bag make sure it’s clear and that there is no sediment, check expiration date,

3 Prime the line (Get fluid all the way through the chamber to the top of the head)

4 spike bag

5 clamp it off

6 pinch the chamber (but not too high)

7 make sure no air

8 Open the clamp and after I see that it went all the way through I would close the clamp

We clean the IV ports with chlorhexidine before we give any med using IV

Back 185

B

Front 186

The dressing for IV must have what things written on it?

Back 186

Date

Time

Size of IV

Front 187

ABO system

Back 187

Allows us to match blood in preparation for blood transfusions

Front 188

True or False: We have our own antibodies that help us fight off things

Back 188

True

Front 189

Universal recipient blood type

Back 189

AB

Front 190

The universal donor blood type

Back 190

Blood type O

Front 191

True or False: We have our own antibodies that help us fight off things

Back 191

True

Front 192

Universal recipient blood type

Back 192

AB

Front 193

The universal donor blood type

Back 193

Blood type O

Front 194

Type A blood

Back 194

A antigen and B antibody

Front 195

TPN

Back 195

Total parenteral nutrition nutrition through IV that has a high concentration which requires us to administer it centrally

Front 196

True or False: The TPN never stay hung more than 24 hours

Back 196

True

Front 197

True or False: with nutritional support the nurse will be coming and making sure that they are falling the recommendations

And are monitoring for edema, looking at output.

If they are following restrictions, plans and guidelines.

Back 197

True