Water Transporter for nutrients waste, product and other substances

Insulator, lubricant, insulator shock absorber, regulation of temperature

Body fluid major compartment
Intracellular Fluid 2/3 Within cells
Plasma
Interstitial fluid
Extracellular Fluid 1/3 Outside the cells, include lymph and intranscellular fluid such as
cerebrospinal fluid, pericardial, pancreatic, pleural, intraocular, biliary,
peritoneal, and synovial fluid
ECF 3 COMPARTMENT
intranscellular fluid Found within the vascular system
Interstitial fluid Found surrounding the cells an includes lymph
Transcellular fluid Includes cerebrospinal fluid, pleural, peritoneal and synovial fluid
Body fluid movement
Osmosis Water molecules move from the less concentrated area to the more
concentrated area in an attempt to equalize the concentration of solutions
on two sides of a membrane
Water Move toward higher concentration
Solutes Are substance dissolved in liquid
Crystalloids Are salts dissolved readily into true solution
Collloids Are salts dissolve readily into true solution
Sodium The major determinant of serum osmolality
Diffusion Is the continual intermingling of molecules in liquid, gas by random
movement of the molecules
Filtration Is the process whereby fluid and solute move together across a
membrane from one compartment to another
Active Transport Substance can move across cell membrane from a less concentrated
solution to a more concentrated one by active transport
Regulating Body Fluids Fluid intake
Thirst
Fluid output
Urine
Insensible
Maintaining homeostasis
Kidney
ADH
Renin-angiotensin-aldosterone system

ECF and ICF ions Anions (-)

Cations (+)
The number of cations and anions SHOULD BE EQUAL
ECF PRINCIPLE Sodium
ELECTROLYTES Chloride
Bicarbonate
Major components of ECF Plasma and interstitial fluids
Primary electrolytes in the ICF Potassium
Magnesium
Phosphate
Sulfate
Regulating Regulation Function
Electrolytes
Sodium Na  Renal reabsorption or excretion  Regulating and distribution
 Aldosterone increases Na reabsorption in  Maintaining blood volume
collecting duct of nephrons  Transmitting nerve impulses
and contracting muscle
contraction
Potassium K  Renal excretion and conservation  Maintaining ICF osmolality
 Aldosterone increases K  Skeletal and smooth muscle
 Movement into and out of cells function
 Insulin helps move K into cells tissue  Regulating acid base balance
damage and acidosis shift K out of cells into  Transmitting nerve and other
ECF electrical impulses
Calcium  Redistribution between bones and ECF  Forming bones and teeth
 Parathyroid hormone and calcitriol increase  Transmitting nerve impulse
serum Ca levels; calcitriols decreases serum  Regulating muscles
levels contractions
 Maintaining cardiac
pacemaker (automaticity)
 Blood clotting
 Activating enzymes such as
pancreatic lipase and
phospholipase
Magnesium  Conservation and excretion by kidney  Intra cellular metabolism
Mg  Intestinal absorption increased by vitamin  Operating sodium-potassium
and parathyroid hormone pump
 Relaxing muscles
contractions
 Transmitting nerve impulses
 Regulating cardiac function
Chloride  Excreted and reabsorbed along with sodium  Regulating cardiac function
in the kidneys  HCL production
 Aldosterone increases chloride reabsorption  Regulating ECF balance and
with sodium vascular volume
 Regulating acid-base balance
 Buffer in oxygen-carbon
dioxide exchange in RBCs
Phosphate  Excretion and reabsorption by the kidney  Forming bones and teeth
 Parathyroid hormone decrease serum levels  Metabolizing carbohydrate,
by increasing renal excretion protein and fat
 Reciprocal relationship with calcium:  Cellular metabolism,
increasing serum calcium levels decrease producing ATP and DNA
phosphate levels; decreasing serum calcium  Muscle, nerve, and RBC
increase phosphate function
 Regulating acid-base balance
 Regulating calcium levels
Bicarbonate  Excretion and reabsorption by the kidney  Major body buffer involved
 Regeneration by kidneys in acid-base regulation
NOTES
 The ph reflects the hydrogen
concentration of the solution
 The higher the hydrogen ion
concentration= lower the ph
(more acidic)
 The lungs and kidneys help
maintain a normal Ph by either
excreting or retaining acids and
bases
 The lungs helps regulate acid-
base balance by eliminating or
retaining carbon dioxide, a
potential acid
 Kidney maintain acid-base balance by
selectively excreting or conserving
bicarbonate and hydrogen ions
 When excess hydrogen ion is present
and the Ph falls acidosis, the kidneys
reabsorb and regenerate bicarbonate
and excrete hydrogen ions
 In the case of alkalosis and high ph,
excess bicarbonate is excretes and a
hydrogen ion is retained
 Combined with water, carbonic
dioxide forms carbonic acid

Buffers  Substances that keeps a constant balance between acid and alkali
 Major buffer in ECF is HCO3 and H2CO3
 Other buffers include:
Plasma protein
Hemoglobin
Phosphates
Major buffer system in ECF Bicarbonate HCO3
Carbonic acid H2CO3
Regulation of Acid- Base Low ph- Acidic
Balance High ph- Alkalinic
Body fluids maintained between ph of 7.35 and 7.45 by
Buffers
Respiratory system
Renal system
Factors Affecting Body  Age
fluid, Electrolyte and Acid –  Gender
Base Balance  Body size
 Environmental temperature
 Lifestyle
Fluid imbalances Fluid imbalances are Isotonic
two basic types Osmolar
NOTES
NOTES
Isotonic ININ
loss DEHYDRATION
ofOVERHYDRATION
water and Fluid volume Isotonic imbalances Occur when water and
The risk for dehydration
Overhydration
electrolytes may occurincreases with
if deficit
only older
water is age due electrolyte are lost or
COLLECTING ASSESSMENT DATA DISTURBANCE IN FLUID AND ELECTROLYTE
gained in equal
to replaced
decreasedorthirst
fromsensation.
the syndrome of inappropriate
Nursing History
Hypovolemia- Decrease blood volume proportions so that the
Risk for gain
dehydration
antidiuretic
Isotonic hormone
water are(SIADH)
and clientsFluid
who are
which can result
volume
Physical Assessment
Hypovolemic-
hyperventilating when
from some malignant intravascular
or havetumors,
prolonged fluid
fever
AIDS, is depleted
or are
head in
injury, osmolality of body
electrolytes excess
Clinical
diabetic measurement-weight
Hypervolemia- increase
ketoacidosisofand
or administration blood
thosedrugs
certain volume
receiving enteral
such as fluids remains constant
Hyperosmolar
Review
Edema of loss
laboratory of ONLY
test results Dehydration Osmolar imbalances Involve the loss of only
feedings with insufficient
barbiturates or anesthesia. water
WATER
Evaluation
Dependent of edema
edema found in the lowest part of the body water so that the
Common
Common manifestations
manifestationofofdehydration
overhydration include
Hypo-osmolar
The nurse
Pitting also
edema=gain
needs ofto elicit Overdehydration
data about the
edema that leaves a depression or pit after finger pressure is applied on the swollen
osmolality area
of the serum
 Weight
Weight loss
gain
ONLY
client’s WATER
food and fluid intake and output, is altered
 Decreases skin turgor
Full bounding pulseand capillary refill
andthe presence
Dry mucousofmembranes
Tachycardia signs or symptoms NOTES
suggestive
 Weak, of altered
rapid fluid
pulse
Elevated blood pressure and electrolyte Water body composition 1500 ml a day of water
balance.
 Decreased
Distended BPneck and peripheral Infant- 70-80% 240cc/8 hrs urinates
 Orthostatic hypotension
veins4adventitious lung sounds Adult-50-60%
 Increased
SOB specific gravity of the urine Older adult- 45-55%
 Hct and blood urea nitrogen
Confusion

ELECTROLYTES NORMAL RANGE

Sodium Na 135-145 mEq/L
Potassium K 3.5-4.5 mEq/L
Chloride Cl 95-108 mEq/L
Calcium Ca 4-5-5.5 mEq/L or 8.5-10.5 mg/dL
Magnesium Mg 1.5-2.5 mEq/L
Phosphate (phosphorus) 1.8-2.6 mEq/L
Serum osmolality 280-300 mOsm/kg water
ABG NORMAL INDICATION
VALUES
Partial pressure 80-100 mmHg Hypoxemia
oxygen (PaO2):  Hyperoxygenatio
n
Partial pressure 35 – 45 mmHg ELEVATE:
carbon dioxide acidosis
(PaCO2) Decrease:
Alkalosis

Arterial blood pH 7.35 - 7.45 <7.35= acidosis

>7.45= alkalosis
Oxygen 95 - 100% <95% =
saturation (SaO2) hypoventilation;
anemia
Bicarbonate 22-26 mEq/L ELEVATE:
(HCO3) Alkalosis
Decrease:
Acidosis
 NORMAL VOLUME INTERPRETATION
Volume Approx. 250ml-400ml per void
Normal production 30ml/hour
1200-1500cc for average adult per 24 hour
500-600 newborns
Color Light yellow
Clarity Clear without sediment
Odor No odor

DIAGNOSIS URINE OUPUT MEASUREMENTS

Normal 800-2000 1 ml 1cc
1 teacup 6 oz
Decreased 500 oliguria 1 ounce 30ml/cc 180ml
Increased >2500-300ml 1 pint 500 ml/cc 1 180 ml
Decreased 100 anuria 1 quart 1000 ml/cc Styrofoam
1glass 8 oz cup
240ml 1 popsicle 3 oz
Desired outcome 1 cup 8 oz
NANDA DIAGNOSIS 90 ml
Maintain or restore normal fluid balance
Deficient fluid volume
Maintain or restore normal balance of
Excess fluid volume
electrolytes
Risk for imbalance fluid volume
Maintain or restore pulmonary ventilation and
oxygenation Risk deficient fluid volume
Prevent associated risk Impaired gas exchange
 Tissue breakdown, decreases cardiac
output , confusion, other neurologic signs
NANDA Nursing Diagnosis
 Fluid and acid-base imbalances as etiology
Nursing Intervention Impaired oral mucous membrane
Monitoring Impaired skin integrity
- Fluid intake and output Decreased cardiac output
- Cardiovascular and respiratory status Ineffective tissue perfusion
- Results of laboratory tests Activity intolerance
Assessing Risk for injury
- Client’s weight Acute confusion
- Location and extent of edema, if present
- Skin turgor and skin status PROMOTING FLUID AND ELECRTROLYTE
- Specific gravity of urine BALANCE
- Level of consciousness, and mental status Consume 6-8 glasses of water daily
- Fluid intake modifications Avoid foods with excess salt, sugar, caffeine
- Dietary changes Eat well-balance diet
- Parenteral fluid, electrolyte and blood Limit alcohol intake
replacement Increase fluid intake before, during and after strenuous
- Other appropriate measures such as: exercise
Administering prescribed medications Replace lost electrolytes
and oxygen Maintain normal body weight
Providing skin care and oral hygiene Learn about monitor, manage side effects of medications
Positioning the client appropriately Recognize risk factors
Scheduling rest periods Seek professional health care for notable signs of fluid
imbalances
 TEACHING CLIENT TO MAINTAIN FLUID
AND ELECTROLYTE BALANCE
Promoting fluid and electrolyte imbalance Medications
Monitoring fluid intake and output Measures specific to clients problems
Maintaining food and fluid intake Referrals
Facilitating fluid intake
Safety Community agencies and other sources of help

PRATICE GUIDELINES FACILITATING Be alert to cultural implications

FLUID INTAKE
Explain reason for required intake and amount
needed
Establish 24 hour plan for ingesting fluids
Set short term goal
Identify fluids client likes and use those
Help clients select food that become liquid at room
temperature
Supply cups, glasses, straws
Serve fluids at proper temperature
Encourage participation in recording intake

PRACTICE GUIDELINES RESTRICTING

FLUID INTAKE
Explain reason and amount of restriction Offer ice chips and mouth care
Help client ingestion schedule Teach avoidance of ingesting chewy, salty, sweet
foods or fluids
Identify preferences and obtain Encourage participation in recording intake
Set short term; place fluids in small containers
ORAL SUPPLEMENT
CORRECTING IMBALANCE Potassium
If client is not vomiting Calcium
If client has not experienced excessive fluid loss Multivitamins
Has intact GI tract and gag and swallow reflexes Sports drinks
Restricted fluids may be necessary for fluid retention
- Vary from nothing by mouth to precise
amount ordered
- Dietary changes NURSING PROCESS APPLICATION
Loss of H2O and electrolyte due to;
 Vomiting
CLIENT AT RISK FOR FLUID AND  Diarrhea
ELECTROLYTE IMBALANCE  Excessive sweating
Post-operative client  Polyuria
Client with severe trauma or burn  Fever
Client with chronic disease as congestive heart failure  Nasogastric suction
Client who are NPO  Abnormal drainage
Client with IV infusion  Anorexia
Client with special drainage  Nausea
Client receiving diuretic  Impaired swallowing
Risk Factor Clinical Nursing Intervention
Manifestation
Hypernatremia Thirst  Monitor fluid intake and
Loss of water Dry, sticky mucous output
 Insensible water membranes  Monitor behaviors
loss Tongue red, dry swollen changes (restlessness,
(hyperventilation or Weakness disorientation)
fever)  Monitor laboratory
 Diarrhea SEVERE findings (serum sodium)
 Water deprivation HYPERNATREMIA:  Encourage fluids as
Gain of sodium  Fatigue, restlessness ordered
 Parenteral  Decreasing level of  Monitor diet as ordered
administration of consciousness (restrict intake of salt
saline solution  Disorientation and foods high in
 Hypertonic tube  Convulsions sodium)
feeding without Laboratory findings: 
adequate water Serum sodium vabove 145
 Excessive use of ,Eq/L
table salt (1 tso Serum osmolality above
contains 2,300 mg 300 mOsm/kg
of sodium)
Condition such:
 Diabetes insipidus
 Heat stroke
Hyponatremia  Lethargy,  Assess clinical
confusion, manifestations
Loss of sodium apprehension  Monitor fluid intake and
 Gastrointestinal  Muscle twitching output
 fluid loss
 Sweating
 Use of diuretics
Gain of sodium
 Hypotonic tube
feedings
 Excessive drinking
of water
 Excessive IV D5W
(Dextrose in water)
administration
 Syndrome of
inappropriate ADH
 Head injury
 AIDS
 Malignant tumor
Risk Factor
Hyperkalemia
DECREASE POTASSIUM
EXCRETION
 Renal failure
 Hypoaldosteronism
 Potassium-conserving
diuretics
 High potassium intake
 Excessive or rapid IV
infusion of potassium
 Excessive use of K
containing salt
substitutes
 Potassium shift out of
the tissue cells into the
plasma (infection,
burns, acidosis)
Hypokalemia
 Vomiting and gastric
suction
 Diarrhea
 Heavy perspiration
 Use of potassium
wasting drugs (ex.
Diuretics)
 Poor intake of
potassium (as with
debilitated clients,
alcoholics, anorexia,
nervosa)
 Abdominal cramps
 Anorexia, nausea,
vomiting
 Headache
 Seizures, coma
Laboratory findings:
 Serum sodium
below 135 mEq/L
 Serum osmolality
below 280
mOsm/kg
Clinical Manifestation
 Gastrointestinal
hyperactivity, diarrhea,
irritability, apathy,
confusion,
 Cardiac dysrhythmias
or areflexia (absence of
reflex)
 Decrease heart rate;
irregular pulse
 Paresthesia and
numbness in
extremities
Laboratory Findings:
Serum potassium above 5.0
mEq/L
Peaked T wave, widenes QRS
on ECG
 Muscle weakness, leg
cramps, fatigue,
lethargy
 Anorexia, nausea,
vomiting
 Decreased deep=tendon
reflexes
 Weak, irregular pulses
Laboratory findings:
Serum potassium below 3.5
mEq/L
Arterial blood gases (ABGs)
may shows alkalosis
 Monitore laboratory data
(serum sodium)
 Assess client closely if
administering hypertonic
saline solutions
 Encourage food and
fluid high in sodium if
permitted (table salt,
bacon, ham, process
cheese)
 Limit water intake as
indicated
Nursing Intervention
 Closely monitor cardiac
status and ECG
 Administer diuretics and
other medications such as
glucose and insulin as
ordered
 Hold potassium and K
conserving diuretics
 Monitor serum L levels
carefully, a rapid drop may
occur as potassium shifts into
the cells.
 Teach clients to avoid food
high in the potassium and
salt substitutes
 Monitor heart rate and
rhythm
 Monitor clients receiving
digitalis (ex: digoxin)
closely, because
hypokalemia increase risk of
digitalis toxicity
 Administer oral potassium as
ordered with food or fluid to
prevent gastric irritation
 Administer IV potassium
solutions at a rate no faster
than 10-20 mEq/h; never
 Hyperaldosteronism T wave flattening and ST administer undiluted
SEGMENT DEPRESSION potassium intravenously. For
ON ECG clients receiving IV
potassium, monitor for pain
abd inflammation at the
injection at the injection site.
 Teach client about
potassium-rich foods
 Teach clients how to prevent
excessive loss of potassium-
rich foods
 Teach clients how to prevent
excessive loss of potassium
(ex, through abuse of
diuretics and laxatives)
Risk Factor Clinical Manifestation Nursing Intervention
Hypercalcemia  Prolonged ST segments  Increase client movement
 Prolonged and exercise
immobilation  Lethargy, weakness  Encourage oral fluids as
Condition such as  Depressed deep-tendon reflexes permitted to maintain a
 Hyperparathyroidism  Bone pain dilute urine
 Malignant of the bone  Anorexia, nausea, vomiting  Teach clients to limit
 Paget’s disease  Constipation intake of food and fluid
 Polyuria, hypercalciuria high in calcium
 Flank pain secondary to urinary  Encourage ingestion of
calculi fiber to prevent
 Dysrhythmias, possible heart constipation
block  Protect a confused client;
monitor for pathologic
Laboratory findings: fractures in clients with
Serum calcium greater than 10.5 mg/Dl long term hypercalcemia
or 5.5 mEq/L (total)  Encourage intake of acid-
Shortened QT intervals ash fluids (prune or
cranberry juice) to
counteract deposits of
calcium salts in the urine

Hypocalcemia  Numbness, tingling of the  Closely monitor

extremities and around the respiratory and
Surgical removal of the mouth cardiovascular status
parathyroid glands  Muscles tremors, cramps; if  Take precautions to
severe can progress to tetany protect a confused client
Condition such as: and convulsion  Administer oral or
 Hypoparathyroidism  Cardiac dysrhythmias; parenteral calcium
 Acute pancreatitis decreased cardiac output supplements as ordered.
 Hyperphosphatemia  Positive trousseau’s and When administering
 Thyroid carcinoma Chvostek’s signs intravenously, closely
Inadequate vitamin D intake  Confusion, anxiety, possible monitor cardiac status and
 Malabsorption psychoses ECG during infusion.
 Hypomagnesemia  Hyperactive deep tendon Teach clients at high risk for
 Alkalosis reflexes osteoporosis about
 Sepsis Laboratory findings:  Dietary sources rich in
 Alcohol use Seru calcium less than 4.5 mg/Dl mEq/l calcium
(total)  Recommendation for
Lengthened QT intervals 1,000 to 1500 mg of
Prolonged ST segments calcium per day
 Calcium supplements
 Regular exercise
 Estrogen replacement
therapy for
postmenopausal women
Risk Factor Clinical Manifestation
Hypermagnesemia  Peripheral vasodilation, flushing
 Nausea, vomiting
Abnormal retention of  Muscle weakness, paralysis
magnesium, as in  Hypotension, bradycardia
 Renal failure  Depressed deep tendon reflexes
 Adrenal insufficiency  Lethargy, drowsiness
 Treatment with  Respiratory depression, coma
magnesium salts  Respiratory and cardiac arrest if
hypermagnesemia is severe
Laboratory findings:
Serum magnesium above 2.5 mEq/L
Electrocardiogram showing prolonged
QT interval, prolonged PR interval,
widened QRS complexes, tall T wave
Hypomagnesemia Shortened ST segments
 Excessive loss from  Neuromuscular irritability with
the gastro intestinal tremors
tract (from nasogastric  Increased reflexes, tremors,
suction, diarrhea, convulsions
fistula drainage)  Positive chvostek’s and
 Long –term use of trousseau’s signs
certain drugs  Tachycardia, elevated blood
(diuretics, pressure, dysrhythmias
aminoglycoside  Disorientation and confusion
antibiotics)  Vertigo
Conditions such as  Anorexia, dysphagia
 Chronic alcoholism  Respiratory difficulties
 Pancreatitis Laboratory findings:
 Burns Serum magnesium below 1.5 mEq/L
Prolonged PR intervals , depressed ST
segments, broad flattened T waves,
prominent U waves
Nursing Intervention
 Monitor vital signs and
level of consciousness
when clients are at risk
 If patellar reflexes are
absent, notify the primary
care provider.
 Advise clients who have
renal disease to contact
their primary care provider
before taking over-the-
counter drugs.
 Assess clients receiving
digitalis for digitalis
toxicity
 Hypomagnesemia
increases the risk of
toxicity
Take protective measures when
there is a possibility of seizures
 Assess the client’s ability
to swallow water prior to
initiating oral feeding
 Initiate safety measures to
prevent injury during
seizures activity
 Carefully administer
magnesium salts as
ordered
Encourage clients to eat
magnesium-rich foods if
permitted (whole grain, meat,
seafood, and green leafy
vegtables)
Refer clients to alcohol treatment
programs as indicated.
RESPIRATORY ACIDOSIS CAUSES
 Hypoventilation-hypoxia  Decrease respiratory stimuli (anesthesia,
 Rapid, shallow respiration drug overdose)
 Decreased BP and vasodilation  COPD
 Dyspnea  Pneumonia
 Headache  Atelectasis
 Hyperkalemia
 Dysrhythmias (increase of potassium)
 Drowsiness, dizziness, disorientation
 Muscle weakness hyperreflexia

RESPIRATORY Alkalosis CAUSES

 Hypoventilation (Increase HR and Depth)  Hyperventilation (anxiety, PE, fear)
 Tachycardia  Mechanical ventilation
 Decreased or normal BP
 Hypokalemia
 Numbness and tingling of extremities
 Seizures
 Anxiety and irritability INCREASE
 Muscle cramping and hyperreflexia
Metabolic acidosis CAUSES
 Headache  DKA
 Decreased BP  SEVERE DIARRHEA
 Hyperkalemia  RENAL FAILURE
 Muscle twitching  SHOCK
 Warm, flushed skin- vasodilation
 N&V, Diarrhea
 Changes in LOC- Confusion, increase
drowsiness
Metabolic alkalosis CAUSES
 Restlessness followed by lethargy  EXCESSIVE GI SUCTIONING
 Dysrhythmias  SEVERE VOMITING
 Compensatory hypoventilation  DIARRHEA
 Confusion (dizzy, irritable)  EXCESSIVE NaHCO3
 Tremore, muscle cramps tingling of
fingers and toes
 N&V, Diarrhea
BLOOD Blood is a fluid connective that circulates continuous around the body, allowing constant
continuously around the body, allowing constant communication between tissues distant
from each other
PLASMA - A clear, straw colored, watery fluid in which several different types of blood cells
are suspended
- Plasma expanders are agents that have relatively high molecular weight and
boost the plasma volume by increasing the osmotic pressure
- They are used to treat patients who have suffered hemorrhage or shock
VOLUME EXPANDERS - Are IV fluid solutions that are bused to increase or retain the volume of fluid in
the circulating blood
TYPES OF VOLUME
EXPANDERS
Crystalloids Are aqueous solution of mineral salts or other water soluble
Example: Normal saline, dextrose, ringers solution
Colloids Are LARGER INSOLUBLE MOLECULES such as dextran, human albumin gelatin blood
CONTRAINDIATION TO - Allergy
PLASMA EXPANDERS - Heart failure
- Severe anemia
- Thrombocytopenia
- Pulmonary edema
- Renal insufficiency
NOTES
Normal adult bladder holds between 500 and 600 ml of urine
People start feeling the urge to urinate when the bladder is about half full
A person with normal bladder function can suppress this urge for up to 1-2 hrs, until the bladder full
Most people urinate 3-6 during day and possibly 1-2 during the night

NOTES (IV FLUID)

Be aware that patients being treated for hypovolemia can quickly develop hypervolemia (fluid overload)
following rapid or over infusion of isotonic fluids.
Document baseline VS, edema status, lung sounds and heart sounds before beginning the infusion and
continue monitoring during and after the infusion
PRECAUTION IN USAGE OF ISOTONIC SOLUTIONS
Frequently assess the patients response to IV therapy, monitoring for signs and symptoms of hypovolemia
such as:
- Hypertension
- Bounding pulse
- Pulmonary crackles
- Peripheral edema
- Dyspnea
- SOB
- Jugular venous distention
Monitor intake and output
Monitor for signs and symptoms of continued hypovolemia, including;
- Urine output and less than 0.5mlkh/hr
- Poor skin turgor
- Tachycardia
- Weak, thread pulse
- Hypotension
- Educate patients and their families about the sign and symptoms of volume overload and dehydration
- Instruct the patient to notify if they have trouble breathing or notice any swelling
- Instruct patient and families to keep the head of the head elevated unless contraindicated
Elevate the head of bed as the 35 to 45 degrees, unless contraindicated
If edem is present, elevate the patients legs
PRECAUTION WITH HYPERTONIC FLUIDS
Hypertonic NaCl soln should be administered only in It is better to store hypertonic sodium chloride soln
high activity areas with constant nursing surveillance apart from regular floor stock IV fluids
for potential complication.
Maintain vigilance when administering hypertonic Shouldn’t be given for an indefinite period of time
saline soln because of their potential for causing
intravascular fluid volume overload and
pulmonary edema
Prescriptions for their use should state the specific
hypertonic fluid to be infused the total volume to be
infused and infusion rate, or the length of time to
continue the infusion
CRYSTALLOID
SOLUTIONS THAT CONTAIN SMALL MOLECULES THAT FLOW EASILY ACROSS THE CELL
MEMBRANES, ALLOWING FOR TRANSFER FROM THE BLOODSTREAM INTO THE CELLS
AND BODY TISSUES
Isotonic The concentration of the particles (solutes) is similar to that of plasma.
So it doesn’t move into cells and remains with the extracellular
compartment thus increasing intravascular volume

Types of isotonic
0.9% sodium cloride
Lactated Ringer’s solution or
Hartmann solution
5% dextrose in water D5W
- Simply salt water that contains only water, sodium and chloride
- It’s called normal saline because the percentage of NaCl in the
soln is similar to the concentration of sodium and chloride in the
intravascular space
- To treat low extracellular fluid, as in fluid volume deficit from;
Hemorrhage, severe vomiting or diarrhea, heavy drainage from
GI suction, fistulas, or wounds
- Shock
- Mild hyponatremia
- Metabolic acidosis (such as ketoacidosis)
- It’s the fluid of choice for resuscitation efforts
- It’s the only fluid used with administration of blood products
- CAUTION: USED CAUTIOSLY IN PATIENTS WHO
HAVE CARDIAC OR RENAL DISEASE- FOR FESR OF
FLUID VOLUME OVERLOAD
- Is the most physiologically adaptable fluid because its electrolyte
content is most closely related to the composition of the body’s
blood serum and plasma
- To replace GI tract fluid losses (diarrhea or vomiting)
- Fistula drainage
- Fluid losses due to burn and trauma
- Patients experiencing acute blood loss or hypovolemia due to
third-space fluid shifts
- BOTH 0.9% NaCl and LR may use in many clinical
situations, but patients requiring electrolyte replacement such
as surgical or burn patients will benefit more from an
infusion of LR
- LR is metabolized in the liver, which converts the lactate to
bicarbonate. LR is often administered to patients who have
metabolic acidosis not patients with lactic acidosis
- Don’t give LR to patients with liver disease as they can’t
metabolize lactate
- LR should be given to a patient whose ph is greater than 7.5
- Is considers as isotonic soln but when dextrose metabolized the
soln actually becomes hypotonic and causes fluid to shift into
 cells
- D5Wprovides free water that pass through membrane pores to
both intracellular and extracellular spces. Its smaller size allows
the molecules to pass more freely between compartments, thus
expanding both compartments simultaneously
- It provides 170 calories per liter, but it doesn’t replace
electrolytes
- The supplied calories doesn’t provide enough nutrition for
prolonged used. But still can be added to provide enough
nutrition for prolonged use. But still can be added to provide
some calories while patient is NPO
- CAUTION: NOT GOOD WITH RENAL FAILURE OR
CARDIAC PROBLEMS = FLUID OVERLOAD
- NOT GOOD WITH PATIENT RISK FOR INTRACRANIAL
PRESSURE- COULD INCREASE CREBRAL EDEMA
- Shouldn’t be isolation to treat fluid volume deficit because it
dilutes plasma electrolyte concentrations
- NEVER MIX DESTROSE WITH BLOOD AS IT CAUSES
BLOOD TO HEMOLYZE
- NOT USES FOR RESUSCITATION because the soln wont
remain in the intravascular space
- NOT USE in the EARLY POSTOPERATIVE PERIOD
because the body’s reaction to the surgical stress may cause an
increase in antidiuretic hormone secretion
Hypotonic Compared with intracellular fluid (as well as compared with isotonic
solutions) hypotonic soln have a lower concentration of solutes
(electrolytes. And osmolality 250 mOsm/L
- Lower the serum osmolality within the vascular space, causing
fluid to shift from the intravascular space to both the intracellular
and interstitial spaces
- These solutions will hydrate cells although their use may deplete
fluid within the circulatory system
It expand the intravascular volume by drawing fluid from the instertitial
spaces into the vascular compartment through their higher oncotic
pressure
The same effect as hypertonic crystalloids soln but it requires
administration of less total volume and have a longer duration of
action because the molecules remain within the intravascular space
longer
TYPES OF HYPOTONIC Its effect can last for several days if capillary wall linings are intact and
FLUIDS working properly
0.4% NaCl - 0.33% sodium chloride, 0.2% 2.5% dextrose in water
- Hypotonic fluids are used to treat patients with conditions
causing intracellular dehydration, when fluids needs to be shiftes
into the cell such as:
Hyponatremia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic state
- PRECAUTION:
- NEVER give hypotonic soln to patients who are at RISK FOR
INCREASE ICP because it may EXECEWRBATE
CEREBRAL EDEMA
 - DON’T USE in patients with LIVER DISEASE, TRAUMA
OR BURNS due to the potential for depletion of intravascular
fluid volume
- Monitor pt. for the sign and symptoms of fluid volume deficit
- In order adult patients, confusion may be an indicator of a fluid
volume deficit patients to inform you if they feel dizzy or just
don’t fell right
-
3% NaCl Prescribe for patients with severe hyponatremia, cerebral edema
5% albumin (Human albumin The most common utilized colloid solutions
solution) It contains plasma protein fractions obtained from human plasma and
works to rapidly expand the plasma volume used for:
Volume expansion
Moderate protein replacement
Achievement of hemodynamic stability in shock states
- Considered a blood transfusion product and requires all the same
nursing precautions used when administering other blood
products
- It can be expensive and its availability is limited to the supply of
human donors
ALBUMIN CONTRAINDICATION
- Severe anemia
- Heart failure
- Known sensitivity to albumin
- Angiotensin-converting enzyme inhibitors should be withheld for
at least 24 hours before administering albumin because of the risk
of atypical reactions, such as flushing and hypotension
SIGNS OF TRANSFUSION REACTION MAY INCLUDE
- Fever
- Flank pain
- Vital sign changes
- Nausea
- Headache
- uticaria
- Dyspnea
- Bronchospasm
IF YOU SUSPECT A TRANSFUSION REACTION, TAKE THESE
IMMEDIATE ACTIONS
- Stop the infusion
- Keep the IV line open with normal saline soln
- Notify physician and blood bank
- Intervene for signs and symptoms as appropriate
- Monitor the patients VS
-

Hypertonic
IV LINES COMMON PROBLEMS
Infiltration When the catheter unintentionally enters the tissue
surrounding the blood vessel and the IV fluid go into
the tissues
Phlebitis Inflammation of blood vessel
Hypothermia When large amounts of cold fluids are infused
rapidly
Local infection (abscess) A microscopic organism may use the tiny hole in the
skin created by the IV catheter to find its way into the
body and cause an infection

REMINDER IN IV FLUIDS
Treat IV fluids as prescription like any other medication
Determine if patient needs maintenance or resuscitation
Choose rate of fluid type baesd on co
Don’t forget about additional IV medications patient is receiving