Fluid Balance

Fluid BalanceSources of water: - Liquids - Foods - Metabolism byproduct

Average Adult IntakeLiquids = 1600Food = 700Metab. = 200 -----------24 hour = 2500

Average Adult OutputUrine = 1500Sweat = 500Water vapor = 300Feces = 20024 hour total = 2500

Maintaining Fluid BalanceNeed to be hydrated in all body areasIf fluid balance is upset, problems can occur

Fluid Volume ExcessRetention of water and Na in the ECFOverhydration

Fluid Volume ExcessCauses ?Inc. intakeDec. u/oPhysical DisordersExcess NaStress/Trauma

EdemaSymptom of manydisordersTypes of edema

Fluid Volume DeficitDeficiency of fluid & electrolytes in the ECFDehydration

Fluid Volume DeficitCauses ?Inadequate intakeLoss of body fluidsProlonged feverInability of body to conserve water

Assessing Fluid BalanceAssess the s/s of various systemsNOT JUST ONE!!

Calculating I & OIntake:all fluids consumedIVstube feeds, irrigationssome foods

Clear liquid dietWaterTeaBlack coffee (sweeten)gingeralebroth

Full liquid dietIce creamMilkPudding

OutputUrineEmesisStools (esp. if loose)Drainage from tubes

Recording I & OTeach pt and family to save output and traytranscribe to graphicremember: 1 ounce = 30 cc

Intravenous solutionsInstilled into the pt.s veinincludes solutions of water, chemical, blood and blood products

Purposes of IVsRestore fluid balancePrevent fluid imbalanceReplace electrolytesProvide nutrition (TPN)Administer meds

Purposes of IVs (cont)Establish IV accessReplace blood components

Types of IV SolutionsIsotonicHypotonicHypertonic

Isotonic solutionsContain equal amount of dissolved particles as normally found in plasma

Examples of Isotonic0.9% Sodium Chloride (Normal Saline)5% dextrose in water (D5W)Lactated ringers (LR)D5NS (0.9% Sodium Chloride)

Hypotonic solutionsContain less dissolved particles than normally found in plasma

Hypotonic (cont.)Shifts F/E out of intra-vascular compartment, hydrating intra-cellular/ interstitial areas.

Examples of hypotonic0.45% sodium chloride (Normal Saline) or 1/2 NSD5 1/2 NS (0.45%)D5 1/3 NS (0.33%)D5 1/4 NS (0.225%)

Hypertonic solutionsContain higher amount of dissolved particles than normally found in plasmadraws F/E into intra-vascular from intracell.

Examples of hypertonic10% dextrose3% sodium chloride

Normal saline0.9% Sodium ChlorideOnly solution to be used for blood or blood product transfusions!!

Electrolytes Often added to IVsMost common is KCLMeasured in: milliequivalents mEq

Electrolytes (cont.)Intracellular: most common is KCLExtracellular: most common is NACL

Nursing responsibilitiesKnow policy/procedureCheck MD order and agree with it!!Check solution/additiveCheck rate

Nursing responsibilitiesCheck and document site - no erythema, edema or painAlways safeguard site!

Blood transfusion responsibilityIf you suspect reaction: - stop the transfusion - open saline wide - call MD - notify blood bank

TPNHyperalimentation - administration of nutrients thru special IV into vein - carbos, fats, proteins

Calculating IV Flow RatesIf using infusion pump: -need to calculate and program ml or cc / hourExamples on board!!

Calculating without a pump:Influencing rate: - size of IV catheter - height of solution - position of site

Calculating Rates

ml. of soln. X DRFhrs. to admin. 60(min/hr)

Drop Rate FactorsMacrodrip: 10, 15, 20 - most commonMicrodrip: 60

Will list DRF on package

Examples1000 cc over 8 hours with DRF of 201000 X 20 = 41.6 8 60 or 42 drops/min

Can Simplify1. Find cc/hr.2. If DRF 20, Divide cc/hr by 3. If DRF 15, Divide cc/hr by 4 If DRF 10, Dividecc/hr by 6

How did we simplify?2. Took second part of equation DRF or 20 = 1 60 60 3

Example1000 cc over 8 hours with DRF of 201. 1000 = 125 cc/hr 82. 125 = 41.6 or 423 drops/min

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