Fluid Balance

Fluid Balance•Sources of water: - Liquids - Foods - Metabolism byproduct

Average Adult Intake

•Liquids = 1600•Food = 700•Metab. = 200 -----------24 hour = 2500

Average Adult Output

•Urine = 1500•Sweat = 500•Water vapor = 300•Feces = 20024 hour total = 2500

Maintaining Fluid Balance

•Need to be hydrated in all body areas

•If fluid balance is upset, problems can occur

Fluid Volume Excess

•Retention of water and Na in the ECF

•Overhydration

Fluid Volume Excess

•Causes ?–Inc. intake–Dec. u/o–Physical Disorders–Excess Na–Stress/Trauma

Edema

•Symptom of manydisorders•Types of edema

Fluid Volume Deficit

•Deficiency of fluid & electrolytes in the ECF

•Dehydration

Fluid Volume Deficit

•Causes ?–Inadequate intake–Loss of body fluids–Prolonged fever–Inability of body to conserve water

Assessing Fluid Balance

•Assess the s/s of various systems

•NOT JUST ONE!!

Calculating I & O

Intake:•all fluids consumed•IV’s•tube feeds, irrigations•some foods

Clear liquid diet•Water•Tea•Black coffee (sweeten)•gingerale•broth

Full liquid diet•Ice cream•Milk•Pudding

Output•Urine•Emesis•Stools (esp. if loose)•Drainage from tubes

Recording I & O•Teach pt and family to save output and tray

•transcribe to graphic•remember: 1 ounce = 30 cc

Intravenous solutions

•Instilled into the pt.’s vein

•includes solutions of water, chemical, blood and blood products

Purposes of IV’s•Restore fluid balance•Prevent fluid imbalance•Replace electrolytes•Provide nutrition (TPN)•Administer meds

Purposes of IV’s (cont)

•Establish IV access•Replace blood components

Types of IV Solutions

•Isotonic•Hypotonic•Hypertonic

Isotonic solutions

•Contain equal amount of dissolved particles as normally found in plasma

Examples of Isotonic

•0.9% Sodium Chloride (Normal Saline)

•5% dextrose in water (D5W)•Lactated ringers (LR)•D5NS (0.9% Sodium Chloride)

Hypotonic solutions

•Contain 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 hypotonic

•0.45% sodium chloride (Normal Saline) or 1/2 NS

•D5 1/2 NS (0.45%)•D5 1/3 NS (0.33%)•D5 1/4 NS (0.225%)

Hypertonic solutions

•Contain higher amount of dissolved particles than normally found in plasma

•draws F/E into intra-vascular from intracell.

Examples of hypertonic

•10% dextrose•3% sodium chloride

Normal saline•0.9% Sodium Chloride•Only solution to be used for blood or blood product transfusions!!

Electrolytes

•Often added to IV’s•Most common is KCL•Measured in: milliequivalents mEq

Electrolytes (cont.)

•Intracellular: most common is KCL•Extracellular: most common is NACL

Nursing responsibilities

•Know policy/procedure•Check MD order and agree with it!!

•Check solution/additive•Check rate

Nursing responsibilities

•Check and document site

- no erythema, edema or pain

•Always safeguard site!

Blood transfusion responsibility

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

TPN•Hyperalimentation - administration of nutrients thru special IV into vein

- carbos, fats, proteins

Calculating IV Flow Rates

•If using infusion pump: -need to calculate and program ml or cc / hour

•Examples 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 Factors•Macrodrip: 10, 15, 20 - most common•Microdrip: 60

Will list DRF on package

Examples•1000 cc over 8 hours with DRF of 20•1000 X 20 = 41.6 8 60 or 42

drops/min

Can Simplify•1. 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

Example•1000 cc over 8 hours with DRF of 20

•1. 1000 = 125 cc/hr

8•2. 125 = 41.6 or 42

3 drops/min