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51 Cards in this Set

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What is the most common fluid and electroylte imbalance in the US?

What is the morbidity rate from this imbalance?
Dehydratation

17-45%
Describe ECFVD and the Level it can be manifested in.
Extra Cellular Fluid Volume Deficite, more commonly called dehydration.
Mild 1-2L 2%
Moderate 3-5L 5%
Severe 5-10L 8%
What is the average daily fluid intake from fluids and solid foods?
Fluid 1500-2000ml

Solid 800ml
Who is at greatest risk for dehydration?
Nursing home residents over the age of 85
What is another name for Third Spacing, and where is it commonly seen?
Ascites is a common name for Third Spacing.

It is seen in the peritoneal, pericardial, pleural and join cavaties.
What are the three spaces wehre fluid is seen?
Inside the Cells (Intracellular)
Around the Cells (Interstitial)
The Bloodstream (Intravascular)
What is the most accurate measurement of fluid volume status?
Weight.
Is thirst always a good tool to measure ECFVD?
No, thirst is diminished in older adults.
When is a client considered to have oliguria?
When urine output is between 10-500ml/day (16-20ml/h)
What vital sign changes are seen with inadequate fluid volumes?
Decrease in SBP, weak pulse, decrease in central venous pressure. Every L of lost fluid caused cardiac output to decrease by 1L/min. HR to increase 8bpm and core temperature to increase 0.3C
Describe some clinical manifestations of Cellular Dehydration.
MM of the mouth and eyes become dry.
Lips crack, tongue furrows,
swallowing is difficult.
Skin tenting is seen.
Feces become hard and less numerous.
Describe some diagnostic findings of fluid deficite.
Osmolality >295
Plasma Na >145
BUN > 25
Plasma Glucose >120
Hematocrit >55%
Urine Specific Gravity >1.030
Is Cola a good source of oral Fluid Volume Replacement?
No, they don't contain adequate electolyte, sugar content may lead to osmotic diuresis, caffeine may lead to diuresis.
What is a danger of giving IV fluids too quickly?
Cerebral Edema
Describe D5W.
It is Hypotonic.
50g dextrose, no electorlytes
Replaces deficites of total body water.
Describe NS or 0.9%NS
It is Isotonic
154mEq/L of Na and Cl
Given for ECF deficites in patients with low Na/CL
Given before/after infusion of blood products.
Describe LR
Lactated Ringers * Isotonic
Na/K/Ca/Cl/Lactate
Burns/Bleeding/Bile Loss/Diarrhea.
No Mg or PO4
Describe D5/LR
Lactated Ringers with Descrose
Hypertonic
Describe D5/NS
Hypertonic
Dextrose and Normal Saline
Describe D5/0.45NS
Hypertonic
D5 and a 1/2
Used as a Maintenance fluid
Describe D5/0.225
Hypertonic
D5 and a 1/4
Used as a Maintainence fluid
What is the ratio of ice chips to fluid water?
2/1
1 Cup of Ice Chips = 1/2 C of Water
Why is tenting not appropriate tool for measuring fluid volumes in older adults?
There is a loss of adipose tissue which causes tenting in addition to fluid volumes.
Name two ways that ECFVE can develop.
Extra Cellurar Fluid Volume Excess can come from 1)Simple Overloading of Fluids
2)Filure to excrete fluids.
What is anasarca?
Massive fluid retention.
Provide some of the typical laboratory findings with FVE.
Plasma Osmalality <275
Plasma Na <135mEq/L
Hematacrit <45%
Specifici gravity <1.010
BUN <8mg/dl
Define 3rd Spacing.
Fluid that shifts into the interstitial space and remains there.
What type of therapy is IV fluid and electrolyte?
Crystalloids
What type of IV fluid is a colloid?
Blood and blood products
Name the three types of infusion based fluid replacements.
TPN - Total Parenteral Nutrition
Crystalloid - IV Fluids and Lytes
Colloids - IV Blood and Blood Products
What is a VAD?
Vascular Access Device
Name three types of VAD.
Valcular Access Devices include Catheters, Cannulas, or Infusion ports designed for repeated access to the vascular system.
When are peripherally placed catheters used?
For short term fluid replacement or post-operative antibiotic administration.
When are central line catheters or Peripherally Inserted Catheters used?
Long term IV therapy.
Define a Macrodrip Tubing.
One that delivers drops that are 10-15gtt/ml.
Define a Microgrip Tubing
One that delivers drops that are 60gtt/ml.
When should KCl be given IV Push?
NEVER. It can be fatal.
Why is the foot avoided as a placement site for an IV in adults?
Development of Thrombophlebitis.
Name 3 Isotonic IV Solutions
NS 0.9%
Lactated Ringers
D5W Dextrose 5% in Water
What can be said about Dextrose in Saline Solutions?
They are always Hypertonic
What parts of IV Fluid Administration can be delegated to AP?
The Venapuncture and IV Placement CAN NOT be delegated.
-AP should advise of burning at site
-Advise if flowrate has changed
-Advise if dressing gets wet
-Advise nurse if fluid in bag becomes low
What size needle is appropritae for
-Fluid placement?
-Surgery?
-Fluid Therapy 22gage is appropriate
-Surgery requires 16-18 guage.
What are benefits and risks for longer tubing?
Longer allows for mobility, but also increases risk for infection, and tripping hazzards.
How far above the proposed site of placment should the tourniqute be placed?
4-6 Inches.
What are some common IV sites for adults?
Cephalic, basilic and median cubital.
What are some rules for selecting an IV site?
Use the Non-Dominate arm, with the most distal site possible.
Avoid areas that are painful to palpation.
Avoid site that will interfere with ADLs.
Define the Phlebitis Scale
0-No Symptoms
1-Erythema w or S pain
2-Pain @ access site w/eryth and/or edema
3-Same as 2 w/strek formation and palpable venous cord.
4-Same as 3 with cord >1 in and purulent drainage
How many steps are there in Infiltration scale?
5 which include 0-4
When should a bag of IV fluids be changed?
When there is less than 50ml in the old bag.
When changing a bag, how much fluid should be in the drip chanmber?
Between 1/3 and 1/2 full.
What is an infiltration?
Occurs when IV fluids enter the surrounding space around the venipuncture site.