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How many liters are in the average person?
- 40Ls of fluid in a 70kg man (60%)
- About 80% water for infants
- Females have less H20 as fat tissue holds less water
What is the break down of fluid in the body?
- Intracellular: 25L
- Extracellular: 15L
- -Interstitial: 10L
- -Intravascular: 5L
What should the average input vs. output be?
1200cc = 1200cc
What should the serum osmolality be?
What are the assessment indicators of body fluid?
- Serum Osmolality
- Skin Turgor
- Peripheral Edema
What are the three methods of intracellular and extracellular fluid movement to maintain homeostasis?
- Filtration- fluid across a membrane because of pressure
- Diffusion- of solid particles
- Active transport-like insulin transporting glucose
osmosis-water is drawn to salt, sugar, proteins
What is the significance of osmolality?
the higher the osmolality, the greater water will move toward it
any IV solution with an osmolality greater than blood
How does colloidal osmotic pressure work?
Plasma proteins help reabsorb the blood at the capillary level and bring it back to the heart
if this doesn't occur, peripheral edema occurs
What is the most accurate indicator of fluid balance?
2.2 lbs = 1 L=1 kg
What does the Renin angiotension system do?
- Decreases urinary output
- Increases absorption of sodium
- Great thing for hypovolemic shock
- Back if CHF as it increases fluids
What is the thirst center?
The thirst center is the hypothalamus
Late sign of water deficit
What does ADH do?
Kidneys to increase sodium and water reabsorption
What does ANF do?
Atrial Natriuretic Factor
Block aldosterone release and increases Urinary Output
What serum osmolality indicates fluid overload and dehydration?
Fluid overload<275-296> Dehydration
What is hypervolemia and what can cause it?
- Excess fluid volume (more water than salt)
- Too much/too fast IV solutions
What are some symptoms of Hypervolemia?
- unexplained weight gain
- Crackles in lung field-pulmonary edema
- S3 heart sound
- Decreased LOC
- Increased ICP
Who gets daily I&Os?
- Cardiac Patients
- Renal Patients
- IV acess
Who is at high risk of hypervolemia?
What is hypovolemia and when does it occur?
Fluid volume deficit (more salt than water)
- Stimulation of the Renin and Angiotension
- DM and DI
- Blood Loss
- NG Tube suction
- Abdominal surgery
What is third spacing and why does it occur after surgery?
Third spacing is fluid in an unusable space
After surgery, the capillaries are leaky and fluid can go places it shouldn't
What are some causes of hypovolemia?
- Excessive Sweating
- Not taking in water
- Diuretics, especially lasix (furosemide
What are some indications of hypovolemia?
- Increased Thirst
- Decreased capillary refill
- decreased BP
- Orthostatic Hypotension
- Dry mucus membranes
- *hypovolemic shock
What are Isotonic solutions and why are they used?
Concentrations match 275-295 mOsm, same tonicity as the blood serum
no net movement in or out of the intravascular space
may be used in low bp, hypotension, hypovolemia, dehydration, to keep vein open
lactated ringers may be used in metabolic acidosis because it breaks down bicarb
isotonic solution is choice for a "fluid challenge" when bp drops
Name the Isotonic solutions
- Lactated ringers (280 mOsm)- great for post op, breaks down bicarb
- .9% NSS
- D5W- isotonic in the bag, but hypotonic one it gets in the body and sugar is eaten up
- -->50g glucose in 1000ccs
- -->170 cal, no salt
What are the contraindications for isotonic solutions?
- lactated ringers contraindicated for those with alkalosis and liver disease
- give too much too fast can cause hypervolemia and dillute the vascular space
- Brain swelling and heart failure
What are Hypertonic solutions and why are they used?
- Have a higher tonicity than serum
- More solutes than solution
- High "drawing power"
- pulls fluids from the cells
- Sugar, salt, proteins that will suck you dry
- -->any sugar + salt, or salt content higher than NSS
- Kidneys will rid the body if renin-angiotension system is intact
- used for:
- post op to combate the "third spacing"
- purposefully dehydrate for a day or two
- PPN (less than 50% glucose)
Name the hypertonic solutions
- D5NSS (560 mOsm)
- D5 1/2NSS
- 3% NSS
- D10W- replacement for TPN due to high sugar load
- D50W-pancreas needs time to acclimatize to these sugar loads
What are the contraindications of hypertonic solutions?
- Intracellular dehydration (diabetes)
- Heart or kidneys are impaired
What are hypotonic solutions and what are they used for?
- osmolality lower than blood serum
- draws water into the cells to "swell them"
- will hydrate cells from the vascular space
- Only for short term use
- Dibetic Ketoacidosis
- Severe intracellular dehydration
Name the times of hypotonic solutions
What are the contraindications for hypotonic solutions?
Monitor for hypotension and cerebral edema
- Don't give in "third spacing" situations such as...
- protein depletion
What are colloids and what are they used for?
Hypertonic solutions that increase protein and do not cross through the blood vessel
- used for...
- recruiting third space fluidsAscitis
- Post op abdominal surgery
- correcting hypotension
- expanding the intravascular space
- increase depleted protein
What are the types of colloids?
What category of fluid would blood therapy fall under? What are the different types of blood products?
- Whole Blood (for active bleeding, like liver trauma)
- FFP (fresh frozen platelets)
- Cryoprecipirate factors
What are the five rights of medication?
- Right Patient
- Right Product
- Right Time
- Right Route
- Right Dose
What do you do if you suspect a reaction to a blood transfusion?
saline at IV site (not piggy backed to blood or you push in the rest of the blood in the line, which can cause a worse reaction)
Call Dr, stay with patient for support
*a febrile reaction normally has a perimeter given by MD
What is the normal range of Potassium?
K+ 3.5-5 mEq/L
What are the s/s of Hyperkalemia?
- Cardiac disrrythmias
- Cardiac arrest
- stomach cramps
What can cause hyperkalemia?
- increased intake and absorbtion of vit K
- rapid infusion of stored blood
- cellular damage from crushing
- potassium sparing diuretics
- adrenal insufficiency
What are the s/s of hypokalemia?
- muscle weakness that may ascend to the lungs
- abdominal distension
- decreased bowel sounds
- cardiac dysrrhyrthmias
What are the causes of hypokalemia?
- treatment of ADK with insulin
- use of potassium wasting diuretics
- acute or chronic n/v/d or gastric lossess
What is the normal range of Sodium?
what are the s/s of hypernatremia?
- extreme thirst
- dry, flushed skin
- postural hypotension
What are the causes of hypernatremia?
- Diabetes Insipidus
- greatly increased sweating
- overuse of salt tabs
- tube feedings or hypertonic feedings
- difficulty asking for or swallowing fluids
- lack of access to water
What are the s/s of hyponatremia?
- decreased LOC
What causes hyponatremia?
- tap water enemas
- excessive ADH
- excessive IV admin of D5W
- v/d with replacement only with water and no salt
What is the normal range of Calium?
What are the s/s of hypercalcemia?
- cardiac dysrrythmias
- diminished reflexes
- decreased LOC
What are the causes of hypercalcemia?
- prolonged immobilization
- bone tumors
- use of thiazide diuretics
What are the s/s of hypocalcemia?
- Chvestek's sign (contraction of facial muscle when facial nerve is tapped)
- Numbness and tingling of fingers and around mouth
- cardiac dysrhythmias
What causes hypocalcemia?
- calcium deficient diet
- vitamin D deficiency
- chronic diarrhea/laxative misuse
What is the normal range of chloride?
What is the normal range of magnesium?
What is the normal range of phosphate?