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85 Cards in this Set

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Intracellular Fluid (ICF)
- Comprises all fluid within the cells of the body
- About 42% total body weight
- Approximately 28 L of body water in the average male and 20 L in the average female
- Fluid Deficit
- Body loses water in intracellular fluids
- Fluids within cells
- ⅔ of total body water
Extracellular fluid (ECF)
All fluid outside a cell
- Broken into 3 compartments
- Interstitial Fluid
- Intravascular Fluid
- Transcellular Fluid
- About 17% of body weight
Interstitial Fluid
Contains lymph, is the fluid between the cells and outside the blood vessels
Intravascular Fluid
Blood plasma found in the vascular system
Transcellular Fluid
Fluid separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal (GI), intraocular, peritoneal, and synovial fluid
Electrolytes
- Substances in water that are also called minerals or salts

- Is an element or compound that when dissolved or dissociated in water or another solvent, separates into ions that are electrically charged
Cation
- Positively charged electrolytes
- Sodium (Na+)
- Potassium (K+)
- Calcium (Ca2+)
Anion
- Negatively charged electrolytes
- Chloride (Cl-)
- Bicarbonate (HCO3-)
- Sulfate (So4-)
Osmosis
- Involves the movement of a pure solvent, such as water, across a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration

*Movement of water across semipermeable membrane from lesser to greater concentration
Osmotic Pressure
Is drawing power of water and depends on the number of molecules in solution
Osmolality
- The osmotic pressure of a solution is its osmolarity

- Expressed in osmols, or milliosmols per kilogram (mOsm/kg) of the solution

- Normal serum osmolality is 275-295 mOsm/kg
Osmolarity
- Another term that describes the concentration of solutions

- Reflects the number of molecules in a liter of solution

- Is measured in milliosmoles per liter (mOsm/L)
- Split into 3 groups
- Hypertonic
- Isotonic
- Hypotonic
Hypertonic
- Solution of higher osmotic pressure
- Ex: 3% sodium chloride
- Pulls fluid from cells causing them to shrink
Hypotonic
- Lower osmotic pressure
- Ex: 0.45% sodium chloride
- Moves fluid into the cells, causing them to enlarge
Colloid Osmotic or Oncotic Pressure
- Tends to keep fluid in the intravascular compartment by pulling water form the interstitial space back into the capillaries

- Albumin exerts this pressure (albumin attracts fluid)

- Low albumin levels could cause low blood pressure but mainly edema
If someone has decreased intravenous fluids then you want to give: hypertonic, hypotonic, isotonic solution
Hypertonic Solution
If someone has edema than fluid is interstitally, then give patient: hypertonic, hypotonic, isotonic solution
Hypertonic.

Hypotonic will make it worse
If someone has low serum sodium give patient: hypertonic, hypotonic, isotonic solution
Hypertonic solution - preferably with high sodium concentrate
Diffusion
- Is the random movement of a solute (gas or solid) in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration

*Movement of solute in solution from high to lower concentration
Filtration
- Process by which water and diffusible substances move together across a membrane in response to fluid pressure, moving from an area of higher pressure to one of lower pressure

*Water and substances move from high to low pressure in response to fluid pressure
Hydrostatic pressure
- Differences determine the movement of water

- Active in capillary beds
Edema
Accumulation of excess fluid in interstitial space
Active Transport
- Requires metabolic activity and expenditure of energy to move substances across cell membrane

*Must pay toll (energy) to cross the bridge

- Ex: sodium-potassium-ATPase pump
- Sodium pumped out
- Potassium pumped in

- Against concentration gradient (uphill)

- Is mechanism by which cells absorb glucose and other substances to carry out metabolism
Osmoreceptors
Continually monitor the serum osmotic pressure, when osmolality increases the hypothalamus is stimulated
Hypovolemia
- Hypothalamus is also stimulated when excess fluid is lost and hypovolemia occurs, as in excessive vomiting and hemorrhage

- Average adult’s intake is about 2200 to 2700 mL per day
- Oral intake accounts for 1100 to 1400 mL
- Solid foods about 800 to 1000 mL and oxidative metabolism 300 mL daily
Antidiuretic Hormone (ADH)
- Stored in the posterior pituitary gland
- Released to changes in blood osmolarity
- Pain, stress, circulating blood volume and some drugs affect ADH production
- ADH prevents diuresis, thus causing the body to save water
- Increase in osmolarity and releases ADH
- Works directly on the renal tubules and collecting ducts to make them more permeable to water
- Body attempts to compensate, there will be a temporary decrease in urinary output
- Changes in renal perfusion initiate the renin-angiotensin-aldosterone mechanism
Renin
- Proteolytic enzyme secreted by the kidneys
- Responds to decreased renal perfusion secondary to decrease in extracellular volume
- Acts to produce angiotension I, which causes some vasoconstriction
Aldosterone
- Adrenal cortex releases aldosterone in response to increased plasma potassium levels or as part of renin-angiotensin-aldosterone mechanism to counteract hypovolemia

- Increases absorption of sodium and secretion and excretion of potassium and hydrogen

- Overall effect of renin-angiotensin-aldosterone mechanism is sodium and water retention, leading to restoration of blood volume
Angiotensin 1
- Vasoconstriction
- With ACE(enzyme) makes

- Angiotensin 2
- Adrenal cortex
- Aldosterone
- Increase reabsorption of sodium
- Attracts H2O
- Conserves H2O`
If someone is bleeding what would you see with angiotensin initially
Initially you will have increased angiotensin 2
Atrial natriuretic peptide (ANP)
- Is a hormone secreted from atrial cells of the heart in response to atrial stretching and an increase in circulating blood volume

- Acts as a diuretic that causes sodium loss and inhibits the thirst mechanism
Fluid Output Regulation
- Fluid output occurs through four organs of water loss: the kidneys, skin, lungs, and the GI tract

- The kidneys are the major regulatory organs of fluid balance

- An average of 500-600 mL of sensible and insensible fluid is lost via the skin each day

- Approximately 3-6 L of isotonic fluid moves into the gastrointestinal tract and then returns again to the extracellular fluid

- Average adult loses only 200 mL of the 3-6 mL each day through feces
- Want to drink about 30 mL/kg
Insensible water loss
- Is continuous and occurs through the skin and lungs
- Increase with fever or burns
- Lungs expire about 500 mL of water daily
- Loss increases in response to changes in respiratory rate and depth
- Devices for administering oxygen increase insensible water loss from the lungs
Sensible water loss
Occurs through excess perspiration and can be perceived by the client or through inspection
If patient has inappropriate antidiuretic hormone what do you do?
- Give administration of ordered loop diuretics
- Promote diuresis
- Excess production of antidiuretic hormone results in hypervolemia and hyponatremia
Cations
- Major cations within the body fluids include
- Sodium (Na+)
- Potassium (K+)
- Calcium (Ca2+)
- Magnesium (Mg2+)
Sodium Regulation
- Is most abundant cation (90%) in ECF
- Major contributors to maintaining water balance through their effect on:
-Serum osmolality
-Nerve impulse transmission
-Regulation of acid-base balance
-Participation in cellular chemical reactions

- Regulated by dietary intake and aldosterone secretion
- Normal extracellular sodium concentration is 135-145 mEq/L
- Most important electrolyte for water balance
- If sodium is low, than there is low water and causes low blood pressure
Potassium Regulation
- Is the major electrolyte and principal cation in the intracellular compartment
- Regulates many metabolic activities and is necessary for
- Glycogen deposits in the liver and skeletal muscle - role in glucose metabolism - no potassium, will see imbalance in glucose levels - hyperglycemia - not surprised if orders insulin and potassium

- Transmission and conduction of nerve impulse - including smooth muscle and skeletal muscle

- Normal cardiac conduction
- Skeletal and smooth muscle contraction
- 2% is located within ECF
- Normal range for serum potassium concentrations is 3.5-5 mEq/L
- Dietary intake and renal excretion regulate potassium
- Body conserves potassium poorly, so any condition that increases urine output decreases the serum potassium concentration
- 80-90% removed from body in urine
Renal failure would need to watch potassium levels because they would...?
Rise - Hyperkalemia
You might see increased heart rate or patient might have cardiac arrhythmias
Calcium Regulation
- Calcium is stored in bone, plasma, and body cells
- 99% is located in bone, 1% in ECF
- Approx 50% of calcium in plasma binds to protein, primarily albumin

- 40% is free ionized calcium
- Remaining small percentage combines with nonprotein anions like phosphate, citrate, and carbonate

- Normal serum ionized calcium is 4.5 - 5.5 mg/dl
- Normal total calcium is 8l5-10.5 mg/dl
- Calcium is necessary for:
- Bone and teeth formation
- Blood clotting
- Hormone secretion
- Cell membrane integrity
- Cardiac conduction
- Transmission of nerve impulses
- Muscle contraction
Magnesium Regulation
Essential for:
- Enzyme activities
- Neurochemical activities
- Cardiac and skeletal muscle excitability

- Plasma concentrations range from 1.5-2.5 mEq/L
- Serum magnesium is regulated by:
- Dietary intake
- Renal mechanisms
- Actions of the parathyroid hormone (PTH)

- About 50-60% of body magnesium is contained within the bone
Anions
3 major anions of body fluids are:
- Chloride (Cl-)
- Bicarbonate (HCO3-)
- Phosphate (PO43-)
Chloride Regulation
- Major anion in ECF
- Transport of chloride follows sodium
- Normal concentrations of chloride range from 95-105 mEq/L
- Serum chloride is regulated by dietary intake and kidneys
Bicarbonate Regulation
- Is major chemical base buffer within body
- Found in both ECF & ICF
- Essential component of carbonic acid-bicarbonate buffering system essential to acid-base balance
- Kidneys regulate bicarbonate
- Normal arterial bicarbonate levels range between 22-26 mEq/L
- Normal venous bicarbonate (carbon dioxide content) is 24-30 mEq/L
Phosphorus-Phosphate Regulation
- Nearly all phosphorus in body exists in form of phosphate (PO43-)
- Phosphate is buffer anion found primarily in ICF
- Assists in acid-base regulation
- Calcium and phosphate are inversely proportional
- If one rises, the other falls

- Promotes normal neuromuscular action and participates in carbohydrate metabolism
- Is normally absorbed through the GI tract
- Is regulated by:
- Dietary intake
- Renal excretion
- Intestinal absorption
- PTH

- Normal serum level is 2.8-4.5 mg/dL
If phosphorus is very high, who have kidney failure and not eliminating phosphorus, calcium levels will...?
Drop
Calcium is important for clotting, cardiac conduction, nerve impulse transmission
Patient has potassium level of 6.8 mEq/L what is priority nursing action?
- Hyperkalemia leads to cardiac conduction problems and possible fatal dysrhythmias, ECG is indicated
Buffer
- Is a substance or a group of substances that can absorb or release H+ to correct an acid-base imbalance
- Arterial pH is an indirect measurement of the hydrogen ion (H+) concentration
- Greater the concentration of H+ more acidic the solution lower the pH
- Ph is also reflection of balance between carbon dioxide (CO2) which is regulated by lungs, and bicarbonate (HCO3) base regulated by kidneys
- Normal values in arterial blood range from 7.35-7.45
- 3 general types of acid-base regulators in body are:
- Chemical (carbonic acid-base buffer system)
- Biological (absorption and release of hydrogen ions by cells)
- Physiological buffering system (lungs and kidneys)
Chemical Regulation
- Largest chemical buffer in ECF is carbonic acid and bicarbonate buffer system
- Co2 + H2O <-> H2CO3 <-> H+ +Carbonic Acid <-> Hydrogen ion + Bicarbonate

- Carbonic acid-bicarbonate buffer system is the first buffering system to react to
- Carbon dioxide increases there is increase in hydrogen ions produces which equals in more carbon dioxide produced

- Lungs primarily control the excretion of carbon dioxide
- Respiratory acidosis = heavy breathing to correct it
- Kidneys control excretion of hydrogen and bicarbonate ions - slower takes 2-3 days to correct any acid imbalance
Biological Regulation
- Occurs when hydrogen ions are absorbed or released by cells
- Occurs after chemical buffering
- Hydrogen ions act as positive and must be exchanged with another positively charged ion
- Second biological buffer is hemoglobin-oxyhemoglobin system
- Carbon dioxide diffuses into RBC and forms carbonic acid
- Carbonic acid dissociates into hydrogen and bicarbonate ions

- Another buffer is chloride shift within RBCs
- Blood is oxygenated in lungs, bicarbonate diffuses into cells and chloride travels from hemoglobin to plasma to maintain electrical neutrality
- Process is referred to as chloride shift and is reciprocal exchange between these anions
Physiological Regulation
- 2 physiological buffers in body are lungs and kidneys
- Ordinarily, increased levels of hydrogen ions and carbon dioxide stimulate respiration
- When the hydrogen concentration changes lungs react by altering rate and depth of respiration
- Ex: with metabolic acidosis respirations increase = in greater amount of exhaled CO2 = decreased acidic level
- Ex: With Metabolic alkalosis lungs retain CO2 by decreasing respirations = increasing acidic level

- In response to acid-base imbalance kidneys increase or decrease bicarbonate production
- Kidneys use ammonia mechanism to regulate acid-base balance
Certain amino acids within renal tubules chemically change into ammonia (NH3-) = forms with hydrogen to make ammonium (NH4) = excreted in urine = releasing hydrogen ions from the body
Hyponatremia
- Lower than normal concentration of sodium in the blood (Serum)
- As sodium loss continues, body continues to preserve blood and interstitial (tissue) volume
- As result sodium in ECF becomes diluted
Hypernatremia
- Greater than normal concentration of sodium in ECF that can be caused by excess water loss or an overall sodium excess
- Body conserves as much water as possible through renal absorption
Hypokalemia
- One of most common electrolyte imbalances
- An inadequate amount of potassium circulates in ECF
- Most common cause is vomiting and use of potassium-wasting diuretics
Hyperkalemia
- Greater than normal amount of potassium in the blood
- Primary cause is renal failure, because any decrease in renal function diminishes the amount of potassium the kidney can excrete
Hypocalcemia
- Represents a drop in total serum and/or ionized calcium
- Results from illness which directly affects the thyroid and parathyroid glands

- Another cause is renal insufficiency
Signs and symptoms
- Often related to diminished function of the neuromuscular and cardiac systems
Hypercalcemia
- Increase in total serum concentration of calcium and/or ionized calcium

- Frequently symptom of underlying disease such as hyperparathyroidism or neoplasm, resulting in excess bone reabsorption with release of calcium
- Seen in patients with bone cancer
Hypomagnesemia
- Drop in serum magnesium
- Occurs with malnutrition and with malabsorption disorders
- Signs and symptoms

- Directly related to neuromuscular excitability and appear very similar to hypocalcemia

- Muscular tremors - hyperactive reflexes
- Tachycardia, confusion, disorientation, hypertension, dysrhythmias
Hypermagnesemia
- Increase in serum magnesium levels

- Depresses skeletal muscles and nerve function

- Result of excess magnesium intake in a client with renal insufficiency

- Depression of acetylcholine leads to a sedative effect, which can lead to:
- Bradycardia
- Electrocardiogram (ECG) changes
- Cardiac arrhythmias
- Decreased respiratory rate and depth
Hypochloremia
- Occurs when the serum chloride level falls below normal
- Chloride imbalance is usually associated with sodium imbalance

- Vomiting or excessive nasogastric or fistula drainage results in hypochloremia because of the loss of hydrochloric acid

- Use of loop and thiazide diuretics also results in increased chloride loss as sodium is excreted
Hyperchloremia
- Occurs when the serum chloride level rises above normal

- Usually occurs when serum bicarbonate value falls or sodium level rises

- Hyper and hypo rarely occur as single disease process but are commonly associated with acid-base imbalance
Arterial blood gas (ABG)
- ABG analysis is the most effective way to evaluate acid-base balance and oxygenation
- Measurement of ABGs involves analysis of six components:

- Determination of ABG levels requires the removal of a sample of blood from an artery for laboratory testing to assess the client’s acid-base status and the adequacy of ventilation and oxygenation
- Draws arterial blood from a peripheral artery (usually the radial) or from an existing arterial line
- Before the arterial blood draw, ensure that the client has an ulnar pulse, to prevent loss of blood flow to the hand if the radial artery is damaged
- Take care to prevent air from entering the syringe because this will affect the blood gas analysis
- To reduce oxygen metabolism of cells, submerge the syringe in crushed ice and transport it immediately to the laboratory
- Apply pressure to the puncture site for at least 5 minutes to reduce the risk of hematoma formation
- Reassess the radial pulse after removing the pressure

Ph 7.35-7.45
PaCO2 35-46 mm Hg
PaO2 80-100 mm Hg
Oxygen Saturation 95-99%
Base excess
Bicarbonate -HCO3- 22-26 mEq/L
PaCO2
- Is the partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of pulmonary ventilation

- Normal range is 35-45 mm Hg
Hyperventilation occurs when
- PaCO2 is less than 35 mm Hg

- Rate and depth increase = more CO2 exhaled = CO2 concentration decreases

- Hypoventilation occurs when PaCO2 is more than 45 mm Hg

- Rate and depth decrease = less CO2 exhaled = more CO2 retained = concentration of CO2 increased
PaO2
- Is partial pressure of oxygen in arterial blood

- Normal range is 80-100 mm Hg
- PaO2 less than 60 mm Hg leads to anaerobic metabolism resulting in lactic acid production and metabolic acidosis

- Normal decline in PaO2 in older adults

- Hyperventilation also causes a decrease in PaO2 resulting in respiratory alkalosis
Base Excess
- Is the amount of blood buffer (hemoglobin and bicarbonate) that exists

- Normal range is +- 2 mEq/L
- High value indicates alkalosis can result from:
- The ingestion of large amounts of sodium bicarbonate solutions (some antacids)

- Citrate excess from rapid blood transfusions
- Intravenous infusion of sodium bicarbonate to correct ketoacidosis

- Low value indicates acidosis usually result of the elimination of too many bicarbonate ions

- Example is diarrhea
Bicarbonate
- Serum bicarbonate HCO3- is the major renal component of acid-base balance

- Kidneys excrete and retain HCO3-
- Principal buffer of the extracellular fluids of the body

- Normal range is 22-26 mEq/L
- Less than 22 mEq/L usually indicates metabolic acidosis, greater than 26 mEq/L indicates metabolic alkalosis
Respiratory Acidosis
- Is a combination of:
- Increased arterial carbon dioxide concentration (PaCO2)

- Excess carbonic acid (H2CO3)
- Increased hydrogen ion concentration (pH less than 7.35)
- Result of hypoventilation
- Causes neurological changes
- Hypoxemia occurs because of respiratory depression

- To compensate for acidosis, kidneys conserve bicarbonate and release hydrogen ions in the urine

- Kidneys are slow to compensate, this process may take 24 hours

Ph<7.35
PaCO2 > 45 mm Hg
- PaO2 normal or < 80 mm Hg, depending on cause of acidosis
- SaO2 normal or < 95%, depending on cause of acidosis

- HCO3- normal if early respiratory acidosis or > 26 mEq/L if kidneys are compensating
K+ > 5.0 mEq/L
Respiratory Alkalosis
Marked by a decreased PaCO2 and increased pH (greater than 7.45)
Body does not usually compensate for respiratory alkalosis because the pH returns to normal before the kidneys can respond


Ph >7.45
PaCO2 <35 mm Hg
PaO2 normal
O2 saturation (SaO2) normal
HCO3- < 22 mEq/L
Ionized Calcium < 4.5 mg/dL
K+ < 3.5 mEq/L
Metabolic Acidosis
- Results because of the high acid content of the blood, which also causes a loss of sodium bicarbonate, the alkaline half of carbonate buffer system, resulting in bicarbonate deficit

- In an attempt to identify the cause of metabolic acidosis, an analysis of serum electrolytes to detect an anion gap may be helpful

- Anion Gap
- Reflects unmeasurable anions present in plasma

- Calculate an anion gap by subtracting the sum of chloride and bicarbonate from the amount of plasma sodium concentration

- Compensation for metabolic acidosis is an increased CO2 excretion by the lungs with an increase in rate and depth of respiration

Ph<7.35
PaCO2 normal or <35 mm Hg if lungs are compensating
PaO2 normal
O2 saturation (SaO2) normal
HCO3- < 22 mEq/L
K+ > 5.0 mEq/L
Metabolic Alkalosis
- Result of the heavy loss of acid from the body or an increase in levels of bicarbonate

- Most common causes are vomiting and gastric suction

- Other causes include:
- Overreaction of metabolic acidosis
- Potassium deficiency
- Hyperaldosteronism
- Use of thiazide therapy that causes an increase in renal excretion of acid

- Compensation occurs with decrease in respiratory rate and if there is no underlying kidney disease, renal loss of bicarbonate

Ph >7.45
PaCO2 normal or >45 mm Hg if lungs are compensating
PaO2 normal
O2 saturation (SO2) normal
HCO3- >26 mEq/L
Ionized calcium <4.5 mg/dL
K+ <3.5 mEq/L
Medications that cause fluid, Electrolyte, and Acid-Base Disturbances
Diuretics
- Metabolic alkalosis, hyperkalemia, hypokalemia

Steroids
- Metabolic alkalosis

Potassium supplements
- Gastrointestinal disturbances, including intestinal and gastric ulcers and diarrhea

Respiratory Center Depressants (Opioid Analgesics)
- Decreased rate and depth of respirations, resulting in respiratory acidosis

Antibiotics
- Nephrotoxicity (vancomycin, methicillin, amino glycosides), hyperkalemia and/or hypernatremia
Could cause diarrhea, nausea, vomiting

Calcium carbonate (Tums)
- Mild metabolic alkalosis with nausea and vomiting

Magnesium hydroxide (Milk of Magnesia)
- Hypokalemia

Nonsteroidal antiinflammatory drugs
- Nephrotoxicity
CBC - Complete blood count
- Part of that would be hematocrit
- Is the percent of RBC to serum
- Could be reflection of patient’s hydration status

- If there is less water component in blood - hematocrit values would be higher

- Dehydrated patient - hematocrit is higher
Creatinine
Measure of protein
Patient who is not urinating blood creatinine levels will increase
If check urine creatinine levels patients kidney is not voiding - urine levels would go low
Urine Specific Gravity
- Patient has dehydration
- Reflects number of particles compared to water component of urine

- Higher concentration if dehydrated
- Urine has inappropriate antidiuretic hormone - patient has diaphoresis - specific gravity is lower
Serum electrolyte levels determines the
- Hydration status
- Electrolyte concentration of the blood plasma
- Acid-base balance
- Routinely performed on any client entering a hospital

- If client is stable, daily weights, intake and output, and direct physical care can be delegated to NAP
Intravenous Solutions
Dextrose in water solutions
Saline Solutions
Dextrose in Saline Solutions
Multiple Electrolyte Solutions
Saline Solutions
- 0.45% sodium chloride (half normal saline) (½ NS)
Hypotonic

- 0.33% sodium chloride (one-third normal saline) (⅓ NS)
Hypotonic

- 0.9% Sodium Chloride (normal saline) (NS
Isotonic
Dextrose in Saline Solutions
- Dextrose 5% in 0.9% sodium chloride (D50.9% NaCl)
Hypertonic

- Dextrose 5% in 0.45% NaCl sodium chloride (D50.45% NaCl)
Hypertonic
Multiple Electrolyte Solutions
- Lactated Ringers (LR)
Isotonic

- Dextrose 5% in lactated Ringers (D5LR)
Hypertonic
Regulating the Infusion Flow Rate
- After initiating the IV infusion and checking the line for patency, regulate the rate of infusion according to the health care provider’s orders

- Too slow a rate can lead to:
- Further cardiovascular and circulatory collapse in a client who is dehydrated, in shock, or critically ill
- Risk of becoming clotted

- Too fast a rate can lead to:
- Fluid overload, resulting in cardiovascular, kidney, and neurological complications in vulnerable clients (older adults or clients with preexisting heart and renal disease

- Adjust fluids that run by gravity through the use of a flow control/regulator clamp

- Fluids infused by an electronic infusion device (EID) or IV volume controller are regulated by a mechanical mechanism set at the prescribed rate

- These devices maintain flow rates, cannula patency, and prevent an unexpected bolus of IV infusion
Complications of IV Therapy
Infiltration
Phlebitis
Fluid Volume Excess
Infiltration
- Occurs when IV fluids enter the subcutaneous tissue around the venipuncture site

- Causes swelling (from increased tissue fluid) and pallor and coolness (caused by decreased circulation) around the venipuncture site

- Pain may be present and usually results from tissue edema

- If infiltration occurs, discontinue the infusion and if IV is still needed, insert a new cannula into a vein in another extremity

- To reduce discomfort, raise the extremity to promote venous drainage and decrease edema

- Wrapping the extremity in a warm, moist towel for 20 minutes promotes venous return, increases circulation, and reduces pain and edema

- Heat therapy can be repeated 3-4 times during the day
Phlebitis
- Is an inflammation of the vein
- Selected risk factors include:
- Type of cannula material
- Chemical irritation of additives and drugs given intravenously (antibiotics)
- The anatomical position of the cannula

- Signs and symptoms may include:
- Pain
- Edema
- Erythema
- Increased skin temperature over the vein
- In some instances, redness traveling along the path of the vein
Fluid Volume Excess
- Occurs when the client has received a too-rapid administration of IV solutions

- Assessment findings include shortness of breath, crackles in lungs, tachycardia

- Weight gain - biggest thing to look for *
- Edema - anuria (less than 100 mL per day)

- Decreased urine output is less than 30 mL per hour

- If signs are present then:
- Slow the rate of IV infusion
- Notify health care provider
- Raise the head of the bed
- Monitor vital signs
Autologous Transfusion
- Is the collection and reinfusion of a client’s own blood

- Can be obtained by preoperative donation up to 5 weeks before the planned surgery

- Client can donate 1-5 units of blood depending on the type of surgery and the ability of the client to maintain to an acceptable hematocrit

- Blood can be salvaged postoperatively from mediastinal and chest-tube drainage and after joint and spinal surgery

- Transfusions are safer for the client because they decrease the risk of complications such as mismatched blood and exposure to blood-borne infectious agents