2. Fluid Balance

3. Sources of water: - Liquids - Foods - Metabolism byproduct

4. Average Adult Intake Liquids = 1600 Food = 700 Metab. = 200 ----------- 24 hour = 2500

5. Average Adult Output Urine = 1500 Sweat = 500 Water vapor = 300 Feces = 200 24 hour total = 2500

6. Maintaining Fluid Balance Need to be hydrated in all body areas If fluid balance is upset, problems can occur

7. Fluid Volume Excess Retention of water and Na in the ECF Overhydration

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

9. Edema Symptom of many disorders Types of edema

10. Fluid Volume Deficit Deficiency of fluid & electrolytes in the ECF Dehydration

11. Fluid Volume Deficit Causes ? –Inadequate intake –Loss of body fluids –Prolonged fever –Inability of body to conserve water

12. Assessing Fluid Balance Assess the s/s of various systems NOT JUST ONE!!

13. Calculating I & O Intake: all fluids consumed IV’s tube feeds, irrigations some foods

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

15. Full liquid diet Ice cream Milk Pudding

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

17. Recording I & O Teach pt and family to save output and tray transcribe to graphic remember: 1 ounce = 30 cc

18. Intravenous solutions Instilled into the pt.’s vein includes solutions of water, chemical, blood and blood products

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

20. Purposes of IV’s (cont) Establish IV access Replace blood components

21. Types of IV Solutions Isotonic Hypotonic Hypertonic

22. Isotonic solutions Contain equal amount of dissolved particles as normally found in plasma

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

24. Hypotonic solutions Contain less dissolved particles than normally found in plasma

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

26. 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%)

27. Hypertonic solutions Contain higher amount of dissolved particles than normally found in plasma draws F/E into intra- vascular from intracell.

28. Examples of hypertonic 10% dextrose 3% sodium chloride

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

30. Electrolytes Often added to IV’s Most common is KCL Measured in: milliequivalents mEq

31. Electrolytes (cont.) Intracellular: most common is KCL Extracellular: most common is NACL

32. Nursing responsibilities Know policy/procedure Check MD order and agree with it!! Check solution/additive Check rate

33. Nursing responsibilities Check and document site - no erythema, edema or pain Always safeguard site!

34. Blood transfusion responsibility If you suspect reaction: - stop the transfusion - open saline wide - call MD - notify blood bank

35. TPN Hyperalimentation - administration of nutrients thru special IV into vein - carbos, fats, proteins

36. Calculating IV Flow Rates If using infusion pump: -need to calculate and program ml or cc / hour Examples on board!!

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

38. Calculating Rates ml. of soln. X DRF hrs. to admin. 60(min/hr)

39. Drop Rate Factors Macrodrip: 10, 15, 20 - most common Microdrip: 60 Will list DRF on package

40. Examples 1000 cc over 8 hours with DRF of 20 1000 X 20 = 41.6 8 60 or 42 drops/min

41. 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, Divide cc/hr by 6

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

43. 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